Vaginal opacification during defecography: direction of vaginal migration aids in diagnosis of pelvic floor pathology.
BACKGROUND
To determine whether direction of vaginal displacement during defecography aids in diagnosing pelvic floor pathology.


METHODS
Ninety patients underwent defecography over a 2-year period. Each study was retrospectively reviewed by three radiologists who recorded whether the vagina was displaced cephalad, caudad, or nondisplaced in relation to the urogenital hiatus. This information was then correlated with radiologic diagnosis rendered for the study.


RESULTS
Of the 26 patients with normal defecograms, 19 (73%; p < 0. 001) demonstrated no vaginal displacement during the procedure. Comparatively, 10 (83%; p < 0.001) of the 12 patients with cystoceles showed caudad vaginal displacement, and no patients with cystoceles showed cephalad displacement of the vagina. Of the 17 patients with rectoceles, 10 (58%) showed cephalad displacement, one (6%) showed caudad displacement, and six (35%) patients showed no vaginal displacement. Thirteen (46%) of 28 patients with enteroceles showed cephalad vaginal displacement, nine (32%) showed no vaginal displacement, and six (21%) demonstrated caudad displacement.


CONCLUSIONS
Caudad displacement of the opacified vagina suggests the presence of a cystocele. Cephalad vaginal displacement is suggestive of the presence of an enterocele or rectocele.
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Department of Radiology, Duke University Medical Center, Box 3808, Erwin Road, Durham, NC 27710, USA.
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D016009:Chi-Square Distribution; D003287:Contrast Media; D019841:Defecography / Q000009:adverse effects; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D020047:Rectocele / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D001745:Urinary Bladder Diseases / Q000000981:diagnostic imaging; D014621:Vagina / Q000000981:diagnostic imaging*
D003287:Contrast Media; D001466:Barium Sulfate