CASE 13862 Published on 28.08.2016

Low enterocele and anterior rectocele on defecography

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Barbara Bonnesen

Hellerup, Denmark;
Email:d010796@dadlnet.dk
Patient

76 years, female

Categories
Area of Interest Abdomen ; Imaging Technique Conventional radiography
Clinical History
A 76-year-old female patient presented with longstanding symptoms of obstructed defecation and incomplete bowel emptying, alternating with episodes of fecal incontinence. She also complained of abdominal pain, more pronounced in the left lower quadrant, and needed laxatives on a daily basis.
Imaging Findings
Defecography initially showing a dilated rectum. During evacuation, an enterocele becomes apparent, being pressured down towards the rectum.
Additionally, an anterior rectocele appears during defecation and clears when the rectum is empty.
Discussion
Constipation is a common problem that affects more than 15% of the population in the western world. The defecation process requires normal colonic transit, anorectal sensation, expulsion force, and coordinated function of the pelvic floor for successful evacuation. The causes of obstructed defecation are wide-ranging [1], but approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation. Obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). [2]
Defecography is an examination which visualizes the functional proporties as well as potential problems and abnormalities of the defecation process. Many of the findings in this case cannot be visualized endoscopically, for example the degree of dilation of the rectum and the ano-rectal angle. Endoceles and rectoceles are sometimes, but not always apparent with other methods of examination. This makes defecography a very useful examination for diagnosing causes for constipation.
After a diagnosis, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fibre diet or laxatives), biofeedback training or surgery. [2]
An enterocele should only be operated when pain and heaviness are predominant symptoms and it is refractory to conservative therapy. [3]
Differential Diagnosis List
Low enterocele and anterior rectocele.
Stricture
Stenosis
Constipation
Spasms of the pelvic floor
Final Diagnosis
Low enterocele and anterior rectocele.
Case information
URL: https://www.eurorad.org/case/13862
DOI: 10.1594/EURORAD/CASE.13862
ISSN: 1563-4086
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