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Updated: May 23, 2025

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
High and low take-off external prolapse phenotypes can be characterised preoperatively on defaecation proctography
E A Cooper1, S Singh1, C Yates1
1Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
Defecating proctography reliably identifies two types of external rectal prolapse: high and low take-off. This imaging technique can distinguish between these phenotypes, aiding in understanding prolapse causes.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Medical Imaging
Background:
- External rectal prolapse is poorly understood, with ongoing debate regarding optimal surgical management.
- Anecdotal evidence suggests distinct pathological phenotypes based on prolapse 'take-off' location, but these have not been formally defined or characterized.
- The relationship between prolapse take-off and its underlying pathophysiology remains unclear.
Purpose of the Study:
- To determine if defecating proctography (DPG) can reliably characterize high and low take-off external rectal prolapse.
- To formally define and describe the terms 'high take-off' and 'low take-off' in the context of rectal prolapse.
- To investigate the potential link between prolapse take-off and underlying pathophysiological mechanisms.
Main Methods:
- Retrospective analysis of prospectively collected data from 88 patients with external rectal prolapse.
- Patients underwent defecating proctography (DPG) between January 2004 and December 2017 as part of routine evaluation.
- Prolapse take-off origin, rectosigmoid junction position at rest, and caudal mobility during straining were assessed relative to sacrococcygeal bony landmarks.
Main Results:
- Defecating proctography (DPG) successfully characterized prolapse take-off in all 88 patients (60% high take-off, 40% low take-off).
- The high take-off group exhibited significantly greater rectosigmoid junction caudal mobility (9 cm vs 5 cm, p=0.001).
- A trend towards a lower resting rectosigmoid position was observed in the high take-off group (S4 vs S3, p=0.08).
Conclusions:
- Defecating proctography (DPG) can effectively identify and differentiate between high and low take-off external rectal prolapse phenotypes.
- This study provides the first formal description and definition of prolapse take-off, proposing distinct causal pathways (connective tissue failure and levator ani factors).
- Prolapse take-off should be considered a prognostic factor in clinical practice and research for external rectal prolapse.
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