Enterocele revealed by simultaneous evacuation proctography and peritoneography: does "defecation block" exist?

Area of Science:

• Gastroenterology and Pelvic Floor Imaging

Background:

• Pelvic floor weakness can lead to enterocele, where the bowel prolapses into the rectogenital space.
• Enteroceles are traditionally considered abnormal on evacuation proctography due to suspected rectal compression and defecation obstruction.

Purpose of the Study:

• To prospectively investigate constipated patients using a combined evacuation proctography and peritoneography technique.
• To identify pelvic peritoneal recesses during defecation and determine if enterocele impairs rectal emptying.

Main Methods:

• Fifty constipated patients underwent peritoneography with contrast medium followed by evacuation proctography.
• Lateral and posteroanterior stress views were analyzed using computerized video capture to assess anatomy and rectal emptying.

Main Results:

• A deep rectogenital pouch was observed in 77% of patients, with 58% containing viscera (enterocele).
• Enterocele was more common in constipated patients than controls, often only apparent during straining.
• Patients with enterocele demonstrated faster and more complete rectal evacuation compared to those without.

Conclusions:

• Combined evacuation proctography and peritoneography is a novel technique for diagnosing pelvic hernias during defecation.
• Deep rectogenital pouches are prevalent in constipated individuals, with over half containing viscera.
• Enterocele does not impede rectal evacuation, necessitating cautious interpretation of this proctographic finding.