R Mibu1, M Hotokezaka, T Kai, Y Tanabe, M Tanaka. 1. Division of Surgery, School of Health Sciences, and Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. mibu@shs.kyushu-u.ac.jp
Abstract
OBJECTIVE: Various types of defaecography have been reported for research purposes. A simplified method for clinical use has not been devised for the assessment of disordered defaecation. The aim of this study was to describe a simplified procedure of defaecography and evaluate its usefulness in the diagnosis of faecal incontinence or obstructed defaecation. PATIENTS AND METHODS: Anorectal manometry and simplified defaecography were performed in 82 consecutive patients. The procedure of defaecography consisted of instillation into the rectum with a 100% weight per volume of barium in the sitting position through a Foley catheter with an inflated balloon, and several series of static radiograph at rest, during squeezing and straining according to deflation of the balloon. RESULTS: Positive rate of barium leakage after barium insertion was significantly higher in incontinent patients than constipated or asymptomatic patients (P < 0.001, respectively). The degree of barium leakage was classified into mild in 18 patients with faecal incontinence, moderate in 4 and severe in 2. Constipated patients had more difficulty trying to expel a catheter than incontinent or asymptomatic patients (P=0.001, P=0.03). Twenty-four percent of patients with obstructed defaecation could not expel the balloon and 48% could not evacuate barium sulphate completely. The positive rate of morphological changes such as rectocele, internal intussusception and band formation was higher in constipated patients than incontinent or asymptomatic patients (P=0.01, P=0.04). CONCLUSION: The grade of barium leakage or balloon prolapse reflected the severity of faecal incontinence. The ability in rectal emptying of the balloon or barium sulphate also correlated with the degree of outlet obstruction. The authors concluded that the present defaecographic technique was useful for the assessment of faecal incontinence or functional outlet obstruction, and recommend it due to its simplicity.
OBJECTIVE: Various types of defaecography have been reported for research purposes. A simplified method for clinical use has not been devised for the assessment of disordered defaecation. The aim of this study was to describe a simplified procedure of defaecography and evaluate its usefulness in the diagnosis of faecal incontinence or obstructed defaecation. PATIENTS AND METHODS: Anorectal manometry and simplified defaecography were performed in 82 consecutive patients. The procedure of defaecography consisted of instillation into the rectum with a 100% weight per volume of barium in the sitting position through a Foley catheter with an inflated balloon, and several series of static radiograph at rest, during squeezing and straining according to deflation of the balloon. RESULTS: Positive rate of barium leakage after barium insertion was significantly higher in incontinentpatients than constipated or asymptomatic patients (P < 0.001, respectively). The degree of barium leakage was classified into mild in 18 patients with faecal incontinence, moderate in 4 and severe in 2. Constipatedpatients had more difficulty trying to expel a catheter than incontinent or asymptomatic patients (P=0.001, P=0.03). Twenty-four percent of patients with obstructed defaecation could not expel the balloon and 48% could not evacuate barium sulphate completely. The positive rate of morphological changes such as rectocele, internal intussusception and band formation was higher in constipatedpatients than incontinent or asymptomatic patients (P=0.01, P=0.04). CONCLUSION: The grade of barium leakage or balloon prolapse reflected the severity of faecal incontinence. The ability in rectal emptying of the balloon or barium sulphate also correlated with the degree of outlet obstruction. The authors concluded that the present defaecographic technique was useful for the assessment of faecal incontinence or functional outlet obstruction, and recommend it due to its simplicity.