Defecography with Video Recording in Patients with Defecatory Disorder

While some information about colonic function may be obtained from fluoroscopic assessment, detailed depiction of function of the rectum and anal canal during defecation is not possible with conventional technique. Defecography is a useful technique of examining the rectum and canal in which the patient is studied while sitting down and video recordings could be obtained during the procedure. To evaluate the clinical usefulness of defecography in patients with anorectal dysfunction, defecographic examinations were retrogradely reviewed.

Thirty symptomatic patients performed defecography. The ratio of men : women was 9 : 21, and the age was 8 to 86 years(mean, 36year). Presenting symptoms included a sensation of rectal blockage during straining, rectal prolapse through the anus, anal pain, etc.. While the patient was in the left decubitus position, 250㎖ of a thick barium past was injected into the rectum. The patient was then seated a toilet chair mounted on the footplate of a remote-control stand. And lateral images and video recording centered over the rectum and true pelvis obtained over a period of several minutes, both at rest and during and sqeezing and straining. The defecographaic results were analyzed for the anorectal angle and perineal descent at rest, sqeezing and during straining. Change of rectal configuration and canal width during staining were reviewed.

Defecation was normal in 5 patients(16.6%). Rectocele was seen in 17case(56.6%). Rectal proplase with or without intususception was 11 case(36.3%), 3 cases(10%) of sigmoidcele, and 2 cases(6.6%) of dynsfunction of puborectalis. There was a 1 case(3.3%) of rectal polyp. Seven cases(23%) show combined findings : 2 cases with rectocele, rectal intussusception and sigmoidcele, 4 cases with rectocele, rectal intussusecption and rectal prolapse, rectocele and dynsfunction of puborectalis in 1 case. The measurement of anorectal angel was 65°-125°(mean, 104°) in resting state, 57°-90°(mean, 63°) in sqezzing, and 78°-115°(mean, 103°) in straining state.

Defecography with video recording is a useful study in assessment and diagnosis of various discase causing anorectal dysfunciton. However, the measurement of anorectal angle was wide range without statistical significance.