title: Cinedefecographic findings in patients with obstructed defecation sindrome. A study in 420 cases.
abstract: OBJECTIVE
  Obstructed defecation syndrome (ODS) represents a very common clinical problem. The aim of this study was to analyze the cinedefecographic findings in a group of patients with ODS.
  
  
  METHODS
  All patients with ODS were prospectively introduced into a database and underwent cinedefecography (CD). The grade of the syndrome was assessed by a new ODS score. The validated Agachan-Wexner Constipation Score System was also used. Four lateral films were taken during resting, squeeze, pushing and postevacuation phases and puborectalis length (PRL), anorectal angle (ARA) and perineal descent were recorded and analysed. The presence of an increased fixed perineal descent (FPD) and dynamic perineal descent (DPD), mucosal rectal prolapse (MRP), recto-rectal intussusception (RRI), recto-anal intussusception (RAI), rectocele (RE), enterocele (ET) and sigmoidocele (SG) were also evaluated.
  
  
  RESULTS
  Between February 2002 and March 2005, 420 patients, 404 (96.1%) females and 16 (3.8%) males with a mean age of 49+/-7.7 (range, 21-77) years, underwent CD. In 362 (86.2%) patients CD showed a combination of different cinedefecographic findings. RE, FPD and DPD in association with RAI or RRI were contemporary observed in 118 (26%) patients. MRP, RRI, FPD, RAI and RE were observed as singular finding in 21 (5%), 19 (4.5%), 12 (2.8%), 3 (0.7%) and 3 (0.7%) patients, respectively. In 6 (1.4%) patients a paradoxical contraction of the puborectalis muscle was observed.
  
  
  CONCLUSIONS
  CD shows that ODS is largely caused by multiple patterns of different abnormalities of the rectum and pelvic floor. Any treatment in symptomatic patients could be designed to treat multiple combinations of different abnormalities.
authors.affiliation: Colorectal Surgery Unit, S. Stefano Hospital, and Division of General Surgery, Federico II University, Naples, Italy. adolfo.renzi@unina2.it
authors.forename: A
authors.initials: A
authors.lastname: Renzi
authors.forename: D
authors.initials: D
authors.lastname: Izzo
authors.forename: G
authors.initials: G
authors.lastname: Di Sarno
authors.forename: A
authors.initials: A
authors.lastname: De Iuri
authors.forename: L
authors.initials: L
authors.lastname: Bucci
authors.forename: G
authors.initials: G
authors.lastname: Izzo
authors.forename: N
authors.initials: N
authors.lastname: Di Martino
mesh_terms: D000328:Adult; D000368:Aged; D002933:Cineradiography; D003248:Constipation / Q000000981:diagnostic imaging*; D003627:Data Interpretation, Statistical; D003672:Defecation / Q000502:physiology*; D019841:Defecography; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging; D006801:Humans; D007443:Intussusception / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000000981:diagnostic imaging*; D020047:Rectocele / Q000000981:diagnostic imaging*; D013577:Syndrome