Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study

Collinson, Rowan; Cunningham, Chris; DʼCosta, H.; Lindsey, Ian

doi:10.1111/j.1463-1318.2008.01539.x

Cited by 118 publications

(91 citation statements)

References 34 publications

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“…Correction of rectoanal intussusception and improvement in fecal incontinence has previously been described following resectional rectopexy, so the findings reported here are not without precedence. 16,17 The important point is that no worsening of continence was demonstrated for the overall cohort. It is also possible that other factors are more important in determining post-STARR incontinence, such as the state of anal sphincter function.…”

Section: Discussionmentioning

confidence: 99%

What Happens in Stapled Transanal Rectum Resection?

Boenicke

Jayne

Kim

et al. 2011

Diseases of the Colon &Amp; Rectum

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Improved constipation after stapled transanal rectum resection is associated with improvement of intussusception, rectocele, and dynamic pelvic floor descent. Postoperative continence is determined by 2 parameters, reduction of intussusception and rectal lumen size, which have opposing effects. Reduction of rectal lumen size may be responsible for new-onset fecal urgency, which is occasionally seen after stapled transanal rectum resection.

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Section: Discussionmentioning

confidence: 99%

What Happens in Stapled Transanal Rectum Resection?

Boenicke

Jayne

Kim

et al. 2011

Diseases of the Colon &Amp; Rectum

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“…Defecography, anorectal physiology and symptoms were discussed in the fortnightly pelvic floor MDT which consists of two colorectal surgeons (both authors), one radiologist, the radiographer who performs defecography, one urogynaecologist and the colorectal nurse specialist who performs anorectal physiology and biofeedback. Fluoroscopy films were reviewed by all MDT members and intussusception was graded according to oxford prolapse grade [1] (Grade 1-High recto rectal intussusception, Grade 2-Low recto-rectal intussusception, Grade 3-High recto-anal intussusception, Grade 4-Low recto-anal intussusception, Grade 5-Complete rectal prolapse). Evacuation time, number of attempts at evacuation and speed of opening of the anal canal were considered as subjective global markers of evacuation efficiency.…”

Section: Methodsmentioning

confidence: 99%

Safety and Efficacy of Laparoscopic Ventral Mesh Rectopexy and Sacrocolpopexy for Rectal Prolapse and Obstructed Defecation: Analysis of First 20 Cases at a UK District General Hospital

Tennakoon¹,

Farook²

2016

Surgery

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Journal of Surgery IntroductionLaparoscopic ventral mesh rectopexy (LVMR) is gaining wider acceptance amongst colorectal surgeons as the technique that can address symptoms of both external and internal rectal prolapse. It also allows correction of any associated rectocele, enterocele and posterior vaginal wall prolapse as well as vault prolapse. The learning curve for LVMR is unknown and there is no consensus on case selection. The aim of this study is to share our results to show that LVMR can be learnt and safely performed by experienced laparoscopic colorectal surgeons in district general hospitals with short term results similar to that of establish centres. MethodologyPrior to start of this retrospective study UK National Health Service Health Research Authority website was consulted and NHS Research Ethics Committee approval was not required. The procedures followed were in accordance with the principles of the Helsinki Declaration of 1975, as revised in 2000.Laparoscopic Ventral Mesh Rectopexy was started at our institution in January 2011. All patients presented with obstructed defecation syndrome (ODS) and rectal prolapse from January 2011 to January 2015 are included in this analysis. Patients presenting to the out patients department with symptoms of difficulty in evacuation, sense of incomplete evacuation, pelleted stools, frequent visits to the toilet, perineal, vaginal or anal digitation, incontinence and pelvic pain were clinically diagnosed as having obstructed defecation. All with such symptoms were investigated with anorectal physiology, defecation proctography, colon transit studies, colonoscopy or sigmoidoscopy as appropriate. Patients with obvious rectal prolapse underwent either colonoscopy or sigmoidoscopy as indicated.Fluoroscopic defecography was performed with vaginal, oral and bladder contrast. Defecography, anorectal physiology and symptoms were discussed in the fortnightly pelvic floor MDT which consists of two colorectal surgeons (both authors), one radiologist, the radiographer who performs defecography, one urogynaecologist and the colorectal nurse specialist who performs anorectal physiology and biofeedback. Fluoroscopy films were reviewed by all MDT members and intussusception was graded according to oxford prolapse grade [1] (Grade 1-High recto rectal intussusception, Grade 2-Low recto-rectal intussusception, Grade 3-High recto-anal intussusception, Grade 4-Low recto-anal intussusception, Grade 5-Complete rectal prolapse). Evacuation time, number of attempts at evacuation and speed of opening of the anal canal were considered as subjective global markers of evacuation efficiency. In the case of rectocele barium trapping in the rectocele was considered significant. All patients with ODS then underwent maximal medical therapy as well as biofeedback. Since 2012 patients are offered trans anal irrigation as a form of conservative treatment if they do not respond to maximal medical therapy. Patients with high grade intussusception (Grade 3 and 4) and reduced AbstractIntroduction: ...

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“…There were 49 cystocoeles on MRI (24 Grade I cystocoeles, 22 Grade II cystocoeles and 3 Grade III cystocoeles) and 35 cystocoeles on ultrasound (13 Grade I cystocoeles, 10 Grade II cystocoeles and 12 Grade III cystocoeles). PPV was 91% (32 true positives, 3 false positives) and NPV was 48% (16 true negatives, A, anal canal; PB, perineal body; PR, puborectalis; R, rectum.…”

Section: Anterior Compartmentmentioning

confidence: 99%

“…10 It may not be possible to grade intussusception on defaecatory imaging without evacuation. 22 Although this series assumes that defaecation MRI is the "gold standard", it is less sensitive than defaecation proctography for intussusception 8,10 owing to the difficulty in rectal emptying during supine MRI compared with upright defaecography. 10 Straining during ultrasound may not be as sensitive for the detection of intussusception as rectal evacuation during defaecatory imaging.…”

Section: Intussusceptionmentioning

confidence: 99%

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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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Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study

Cited by 118 publications

References 34 publications

What Happens in Stapled Transanal Rectum Resection?

What Happens in Stapled Transanal Rectum Resection?

Safety and Efficacy of Laparoscopic Ventral Mesh Rectopexy and Sacrocolpopexy for Rectal Prolapse and Obstructed Defecation: Analysis of First 20 Cases at a UK District General Hospital

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

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