Evacuation proctography: a reappraisal of normal variability

Palit, Somnath; Bhan, Chetan; Lunniss, Peter J.; Boyle, D. J.; Gladman, Marc A.; Knowles, Charles H.; Scott, S. M.

doi:10.1111/codi.12595

Cited by 98 publications

(134 citation statements)

References 34 publications

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“…32 This implies that normal findings on MRI also require further evaluation and highlights the flaws in comparing imaging modalities and the need to correlate sonographic findings with symptoms.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction

Hainsworth¹,

Pilkington²,

Grierson³

et al. 2016

The British Journal of Radiology

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Cite this article as:Hainsworth AJ, Pilkington SA, Grierson C, Rutherford E, Schizas AMP, Nugent KP, et al. Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction. Objective: Defaecatory MRI allows multicompartmental assessment of defaecatory dysfunction but is often inaccessible. Integrated total pelvic floor ultrasound (transperineal, transvaginal, endoanal) may provide a cheap, portable alternative. The accuracy of total pelvic floor ultrasound for anatomical abnormalities when compared with defaecatory MRI was assessed. Methods: The dynamic images from 68 females who had undergone integrated total pelvic floor ultrasound and defaecatory MRI between 2009 and 2015 were blindly reviewed. The following were recorded: rectocoele, enterocoele, intussusception and cystocoele. Results: There were 26 rectocoeles on MRI (49 rectocoeles on ultrasound), 24 rectocoeles with intussusception on MRI (19 rectocoeles on ultrasound), 23 enterocoeles on MRI (24 enterocoeles on ultrasound) and 49 cystocoeles on MRI (35 cystocoeles on ultrasound). Sensitivity and specificity of total pelvic floor ultrasound were 81% and 33% for rectocoele, 60% and 91% for intussusception, 65% and 80% for enterocoele and 65% and 84% for cystocoele when compared with defaecatory MRI. This gave a negativepredictive value and positive-predictive value of 74% and 43% for rectocoele, 80% and 79% for intussusception, 82% and 63% for enterocoele and 48% and 91% for cystocoele. Conclusion: Integrated total pelvic floor ultrasound may serve as a screening tool for pelvic floor defaecatory dysfunction; when normal, defaecatory MRI can be avoided, as rectocoele, intussusception and enterocoele are unlikely to be present. Advances in knowledge: This is the first study to compare integrated total pelvic floor ultrasound with defaecatory MRI. The results support the use of integrated total pelvic floor ultrasound as a screening tool for defaecatory dysfunction.

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Section: Discussionmentioning

confidence: 99%

Accuracy of integrated total pelvic floor ultrasound compared to defaecatory MRI in females with pelvic floor defaecatory dysfunction

Hainsworth¹,

Pilkington²,

Grierson³

et al. 2016

The British Journal of Radiology

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“…This technique has provided great insight in the process of normal and abnormal defecation. Many contour abnormalities can be found in healthy volunteers (Palit et al 2014;Shorvon et al 1989), which questions the clinical relevance of these findings in patients. In normal defecation, the puborectal sling relaxes, the anorectal angle obliterates and the rectum empties in 2 min with hardly any contrast remaining (Fig.…”

Section: Defecography: Visualization Of Defecationmentioning

confidence: 99%

Physiology of the Rectum and Anus

Felt‐Bersma¹

2015

Coloproctology

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The anorectal area is a complex area where autonomic and somatic structures coordinate to maintain continence and to regulate defecation. The fecal bolus entering the rectum is perceived, and by a reflex mechanism, the internal anal sphincter relaxes and allows the content to enter the proximal anal canal, where depending on content and situation conscious relaxation or contraction of the external anal sphincter and puborectal muscle will follow.With anal endosonography or MRI, the integrity of the sphincters and pelvic floor can be established. The physiology of the anus and rectum can be tested with anal manometry. This allows measuring of the anal resting and squeeze pressure. Furthermore, relaxation during attempted defecation and the distention reflex can be observed. The process of defecation can be observed with defecography.

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“…A recent report of defecography in normal volunteers reported a mean radiation dose of 0.6 mSv (effective dose 01-1.0 mSv) [ 146 ]. Goei and Kemerink estimated the mean effective dose at 4.9 mSv for female patients and 0.6 mSv for males, given the testes receive only scattered radiation [ 147 ].…”

Section: Defecographymentioning

confidence: 99%

“…Lateral and posterior rectoceles have also been described in male and female patients [ 153 ]. Rectoceles are very common, and may be seen in up to 93 % of asymptomatic females, regardless of parity [ 146 ]. The size of the protrusion from the anterior rectal wall can be measured; rectoceles smaller that 2 cm are regarded as clinically insignifi cant.…”

Section: Rectocelementioning

confidence: 99%