Proctography

Significance of defecography and the role of rectocele in constipated patients

“…The relevance of rectocele has varied in the literature, with some authors emphasizing size greater than 3 cm or rectocele with retained contrast material as rectocele that are clinically significant [29,30]. Other authors have used rectocele greater than 4 cm with delayed or absent emptying as their guidelines for rectocele relevance [31]. Defecography does not predict the outcome of rectocele repair but identifies the anatomy and any other pathologic abnormalities [32].…”

Long-Term Follow-Up of Simultaneous Abdominoperineal Repair of Enterorectocele and Internal Mucosal Prolapse

“…The finding that up to 66 percent of patients may have psychoneurosis, anismus, or rectal hyposensation suggests that these ''underwater rocks'' need to be detected to avoid sinking the ''surgical ship.'' 1 Kodner once stated that he would never operate on a patient with rectal intussusception before obtaining a psychological evaluation, 25 and mental distress has been reported as a negative predictor after colectomy for slowtransit constipation. 25 Nevertheless, few studies on surgery for enterorectocele, recto-rectal intussusception, or internal mucosal prolapse report a preoperative psychological evaluation of the patient candidate for surgery, and very few report a preoperative assessment of rectal sensation.…”

A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’

“…Rectal intussusception, which is detectable in 40% in subjects with normal bowel habit [14], may be diagnosed either by endoanal US, as it may show a double hypoechoic circle representing the two intussuscepted layers of the rectal wall, or by defecography; an incidence of recurrent constipation of 50% at 4 years after resection‐rectopexy for intussusception has been reported [6].…”

“…The patients with psychoneurosis, especially if depressed, tend to keep both emotions and faeces inside. Some surgeons will not operate on a constipated patient with rectal intussusception before psychological work-up [14]. The draw-the-family test may help the clinician to investigate the psychological pattern of the patient without referral to a psychologist.…”

“…Rectocele Inspection, digital examination, defecography Rectal internal mucosal prolapse Inspection, proctoscopy and/or defecography Occult diseases Functional Slow transit-irritable bowel, no stool in the rectum and/or painful spastic sigmoid on examination, and persistence of more than 80% of the ingested markers after 5 days at abdominal X-ray Rectal hyposensitivity, decreased rectal sensation at volumetry/manomety, i.e. onset of feeling more than 20 ml, call for stool more than 60 ml, maximal urgency more than 120 ml Pudendal neuropathy Anal sensation and reflex reduced or absent Gland/clitoris-anal reflex impaired, PNTML longer than 2 ms at EMG Voluntary contraction shorter than 10 s at anal manometry Anismus or non relaxing puborectalis muscle on straining at digital examination, anal manometry and anal-vaginal US Failure of anorectal angle widening at defecography Anxiety- Rectal intussusception, which is detectable in 40% in subjects with normal bowel habit [14], may be diagnosed either by endoanal US, as it may show a double hypoechoic circle representing the two intussuscepted layers of the rectal wall, or by defecography; an incidence of recurrent constipation of 50% at 4 years after resection-rectopexy for intussusception has been reported [6].…”