Simultaneous dynamic proctography and peritoneography for pelvic floor disorders.
OBJECTIVE
We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness/prolapse, and/or chronic intermittent pelvic floor pain.


METHODS
Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining pelvic x-rays were obtained in all patients, and defecation was videotaped using fluoroscopy.


RESULTS
Simultaneous DPG and peritoneography identified clinically suspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the technique in three of the women studied. Rectoceles and rectal prolapse that were identified during physical examination were confirmed by DPG with peritoneography. Simultaneous DPG and peritoneography also gave a qualitative assessment of the severity and clinical significance of the identified pelvic floor disorders. Results of simultaneous DPG and peritoneography affected operative treatment planning in 85 percent of patients studied.


CONCLUSIONS
Simultaneous DPG and peritoneography identifies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for better treatment planning in selected patients with obstructed defecation and pelvic prolapse.
Sentovich
S M
SM
Department of Surgery, New England Deaconess Hospital, Boston, Massachusetts, USA.
Rivela
L J
LJ
Thorson
A G
AG
Christensen
M A
MA
Blatchford
G J
GJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017699:Pelvic Pain / Q000000981:diagnostic imaging; D010537:Peritoneum / Q000000981:diagnostic imaging*; D011859:Radiography; D012005:Rectal Prolapse / Q000000981:diagnostic imaging; D012007:Rectum / Q000000981:diagnostic imaging*; D014596:Uterine Prolapse / Q000000981:diagnostic imaging
D003287:Contrast Media