Clinical, endoscopic and radiological assessment of patients with obstructed defecation: findings and management at a District General Hospital

Abstract

Background: The aim of the study was to determine the diagnostic value of clinical, endoscopic and proctographic assessment as well as clinical outcomes in patients with obstructed defaecation (OD). The study also examined correlation between clinical/endoscopic findings and proctogram in the diagnosis of rectocele and intra-rectal intussusception (IRI).Methods: Patients presenting with symptoms of OD between January-December 2018 were assessed with manual examination, endoscopy and defecation proctogram. Patients were followed for 2-3 years for clinical outcomes.Results: There were 65 female (97.01%) and 2 male patients (2.98%), with an average age of 57.77 (34-88) years. Main indications were OD, altered bowels, faecal urgency and rectal bleeding. A total of 67 X-ray defecating proctograms and 77 endoscopies were performed. Main findings on clinico-endoscopic examination were IRI (44), rectocele (36) and haemorrhoids (21). Main findings on proctogram were rectocele (59), IRI (56) and enterocele (13). Endoscopic assessment showed sensitivity: 55.93%, specificity: 62.50% and accuracy: 56.72% in diagnosing rectocele when compared with the diagnostic confirmation on proctogram. Combining manual assessment with endoscopic findings improved sensitivity (76.27%) and accuracy (68.66%). Similar improvement was also noted in the sensitivity (61.40 to 66.67%), specificity (47 to 58%), and accuracy (53.73 to 58.21%) in diagnosing IRI when compared with the diagnostic confirmation on proctogram. Majority of the patients improved with conservative measures; however, surgical intervention was required in 13 patients.Conclusions: Although manual examination enhances endoscopic assessment in diagnosing rectocele and IRI, proctogram is still required for objective assessment. Management of OD remains mainly conservative, with surgical intervention required in some patients.