RRS is still the main means of assessing the level of a rectal tumour from the anal verge, but MRI has value in determining the level of the tumour in relation to the PR, which cannot be seen on endoscopy.
Objectives: To investigate the prevalence and locations of pelvic adhesions following previous Caesarean section (CS), to identify risk factors for their formation and symptoms associated with their presence. Methods: This was a prospective observational study of women with history of one or more previous CS who attended for a gynecological ultrasound examination. In all women both transvaginal and transabdominal scans were performed in order to identify the presence of pelvic adhesions. Past medical and surgical history was recorded and a structured questionnaire was used to enquire about any history of pelvic pain and urinary symptoms. Results: A total of 308 women were recruited into the study. On ultrasound examination 139/308 (45.1%, 95% CI 39.7-50.7) women had evidence of adhesions within the pelvis. Adhesions in the vesico-uterine pouch were the most common and they were found in a total of 79/308 (25.6%, 95%CI 20.7-30.5) women. In women with no other surgery other than Caesarean section(s) (n = 220), increasing number of CS (OR 3.4, 95% CI 2.1-5.5) and a post operative wound infection (OR 11.7, 95% CI 3.5-39.5) increased the likelihood of adhesions in the anterior pelvic compartment. There was a significant association between presence of anterior compartment adhesions and chronic pelvic pain. Multivariate logistic regression analysis selected anterior abdominal wall adhesions (OR 2.4, 95% CI 1.6-3.7) and any adhesions on scan (OR 2.6, 95% CI 1.2-5.7) as independently predictive of chronic pelvic pain. Conclusions: Pelvic adhesions are present in more than a third of women with a history of previous CS and they are associated with chronic pelvic pain.OC16.04
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