Case: 227

"Enterocele" On Defecography

Show  

History: 66 yo male with history of difficulty with complete evacuation and overflow diarrhea.
Solution: Defecography is a mechanism by which functional issues with defecation can be more fully evaluated. It involves the use of a thick barium paste to simulate stool, as well as small bowel contrast, vaginal contrast (when appropriate), and sometimes bladder contrast. The most common abnormalities are issue related to pelvic floor laxity and include, rectal prolapse, cytoceles, vaginal prolapse, intussusception, rectoceles, and as in this case enteroceles. Enteroceles occur almost exclusively in women, but can be seen in male patients after prostatectomy. This patient was a male without history of prostatectomy, so this diagnosis is very unusual and must be related to a developmental issue related to the pelvic floor. The small bowel can be seen to descend below the normal level of the pelvic floor during evacuation and places mass effect on the adjacent rectum limiting the ability to empty the colon and rectal vault.

Radiograph Images

Questions

The findings on this examination show evidence of:
  • Cystocele
  • Sigmoidocele
  • Intussusception
  • Inability to relax pelvic floor
  • Enterocele
  • Normal study
This is a typical diagnosis for this demographic.
False
Briefly describe how this exam is performed.
Contrast is administered PO to opacify small bowel. Vaginal paste is placed. Sometimes, a urinary catheter is positioned to administer bladder contrast. A thick barium paste is placed in the rectum and then fluoroscopic imaging is performed during rest, squeezing, straining, and evacuation of the rectum.