A combination of pelvicography and colpocystodefecography and defecography for the diagnosis of outlet obstructive constipation / 中国普通外科杂志

ABSTRACT

Objective To study the morphologic and structural changes of the pelvic floor and corresponding visceras in patients with outlet obstructive constipation (OOC). Methods We used simultaneous pelvicography and colpocystodefecography (PCCD), including pelvicography, vaginal opacification, voiding cystography and defecography in 38 patients with OCC and 12 healthy volunteers. Anorectal angle, the level of perineum, and bladder were measured. Results Internal rectal prolapse (IRP) in 37 cases, rectocele (RC) in 5 cases and spastic pelvic floor syndrome (SPFS) in 5 cases were diagnosed by PCCD. While common physical examination alone detected only 12 cases, 4 RC cases and one SPFS case, which were confirmed by PCCD. Moreover, PCCD found 9 cases of pelvic floor hernia or peritoneoceles, 6 cases of cystoceles, 3 cases of descending perineum syndromes, and 10 cases of uterine prolapses. Compared with controls, OOC patients had a larger anorectal angle during defecation, abnormal descending of perineum at rest and defecation, and a deep pouch of Douglas during defecation. Some patients with urinary system symptoms have an abnormal descent of bladder during rest and defecation. Conclusion PCCD has a higher detection rate than common physical examination in diagnosing IRP and RC, and provides information for diagnosis of pelvic floor hernia or peritoneocele, cystocele or uterine prolapse. PCCD helps in the selection of a proper surgical procedure for OOC patients.