[Role and significance of pelvic four-contrast defecography in the diagnosis of outlet obstructive constipation].
OBJECTIVE
To study the changes in pelvic floor morphology and relationships of the pelvic organs in patients with outlet obstructive constipation (OOC).


METHODS
Fifty-nine OOC patients and 12 healthy volunteers were examined by simultaneous pelvic four-contrast defecography, including pelvicography, vaginal opacification, voiding cystography and defecography. The levels of perineum, peritoneum and bladder, and anorectal angle were measured and recorded.


RESULTS
Among the 59 OOC patients, 46 cases of internal rectal prolapse (IRP), 29 cases of pelvic floor hernia, 7 cases of rectocele (RC), 7 cases of spastic pelvic floor syndrome (SPFS), 5 cases of descending perineum syndrome were diagnosed by pelvic four-contrast defecography. Six cystoceles and 10 uterine prolapses were also found by pelvic four-contrast defecography. Compared with healthy volunteers, OOC patients had significantly large anorectal angles during defecation (P<0.05), abnormality descending of perineum during rest and defecation (P<0.05, P<0.01), and a deep pouch of Douglas during defecation (P<0.01). OOC patients combined with urinary system symptoms had an abnormal descent of the bladder during rest and defecation (P<0.05, P<0.01).


CONCLUSIONS
Pelvic four-contrast defecography is an effective method for the diagnosis of IRP, RC, pelvic floor hernia, peritoneocele, cystocele and uterine prolapse, and is helpful in the selection of proper surgical procedures for the treatment of OOC.
Liu
Bao-hua
BH
Department of General Surgery, Daping Hospital, Research Institute of Field Surgery, The Third Military Medical University, Chongqing 400042, China. LBH57268@163.com
Fang
Shi-wen
SW
Zhang
Sheng-ben
SB
Gong
Shui-gen
SG
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003248:Constipation / Q000000981:diagnostic imaging* / Q000209:etiology; D019841:Defecography / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging*