Contrast medium gel for marking vaginal position during defecography. Radiology 182: 278-279

McMaster University Medical Centre, Hamilton, Ont, Canada.
Radiology (Impact Factor: 6.87). 02/1992; 182(1):278-9. DOI: 10.1148/radiology.182.1.1727297
Source: PubMed


A tampon soaked with contrast medium, which had been inserted into the vagina as part of standard defecography procedure, obscured signs of anterior rectocele and rectal intussusception in a 34-year-old woman. A contrast medium gel for marking vaginal position was formulated, and postsurgical examination with use of the gel revealed improved rectal function and no intussusception. The gel provided excellent contrast without obscuring important diagnostic information.

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    ABSTRACT: We reviewed the medical records and defecograms in 55 consecutive patients to determine the impact of results of defecography on clinical management. Main indication for defecography was constipation, present in 40 (73%) of 55 patients. In the remaining 15 patients, indications included obstructed defecation (5), incontinence (5), and miscellaneous symptoms (5). Defecography evaluated pelvic floor motion by assessing changes in the anorectal angle (ARA) and anorectal junction (ARJ) during various maneuvers, extent of evacuation, and structural abnormalities. Patients were grouped based on results of defecography as being normal (26) or abnormal (29). Comparison of measurements of the ARA and ARJ with various maneuvers showed no significant differences between the two groups. Clinical impact was determined by analyzing therapy done following defecography and subsequent patient response. In the normal group, 15 patients were managed medically, seven surgically, and four lost to follow-up. Clinical improvement occurred in 13 (59%) of 22 patients, with similar results between medical (60%) and surgical (57%) therapy. In the abnormal group, 16 had medical management, seven surgical therapy, and six lost to follow-up. Clinical improvement occurred in 13 (57%) of 23 patients but surgical therapy showed more improvement. In conclusion, most standard measurements of the ARA and ARJ were of no value in determining abnormality. Results of defecography did not alter selection of medical or surgical therapy, and had little impact on patient response to therapy.
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    ABSTRACT: Defecography is commonly used in investigation of pelvic floor and anorectal dysfunction, and incorporates measurement of pelvic floor movement during various maneuvers. These measurements are usually referenced to bony landmarks, particularly the ischial tuberosities. These bony landmarks may be difficult to visualize; theoretically, the use of digital subtraction in filming defecography studies should eliminate the need to pinpoint bony position. We filmed 25 defecogram studies in both non-subtracted and subtracted formats, and interpreted each study blindly, subsequently comparing diagnoses and measurements. Subtraction was of limited benefit in only one case, was impossible in one case, added no useful information in 18 cases, and hindered visualization of abnormalities in five cases. Because of the multiple overlapping densities and the inability to restrict patient movement, digital subtraction is unhelpful in defecography.
    Abdominal Imaging 05/1995; 20(3):245-7. DOI:10.1007/BF00200406 · 1.63 Impact Factor
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