HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) AVI movies Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hetzer, F. H. Articles by Weishaupt, D. Search for Related Content PubMed PubMed Citation Articles by Hetzer, F. H. Articles by Weishaupt, D.

MR Defecography in Patients with Fecal Incontinence: Imaging Findings and Their Effect on Surgical Management¹

¹ From the Division of Visceral and Transplantation Surgery (F.H.H.), Institute of Diagnostic Radiology (G.A., C.T., D.W.), and Department of Gastroenterology (U.S.), University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland. Received April 19, 2005; revision requested June 15; revision received July 8; accepted July 20; final version accepted September 7. Address correspondence to D.W. (e-mail: dominik.weishaupt{at}dmr.usz.ch).

View larger version (145K): [in a new window]   Figure 1: Midsagittal contrast material–enhanced T1-weighted spoiled gradient-recalled-echo MR image (22.4/10.6) in a 60-year-old woman with fecal incontinence, obtained at rest in the sitting position. The distance between the bladder (B) base (1, anterior pelvic compartment), vaginal vault (2, middle pelvic compartment), and anorectal junction (3, posterior pelvic compartment) was measured with regard to the PCL at a separate workstation. U = uterus.

View larger version (169K): [in a new window]   Figure 2a: Midsagittal spoiled gradient-recalled-echo MR images (22.4/10.7) in an 83-year-old woman with passive fecal incontinence and a history of two vaginal deliveries and hysterectomy, obtained at (a) rest, (b) squeezing, and (c) defecation. The patient was unable to hold the entire enema because of passive fecal incontinence. In a, a moderate cystocele (1; anterior compartment measurement, 5.9 cm) and a large rectal descent (2; posterior compartment measurement, 8.1 cm) are visible. The ARA at rest () is 136°. In b, there is nearly no change in the size of the cystocele (5.6 cm), the extent of rectal descent (8.2 cm), or the ARA (139°). In c, there is nearly no change in the size of the cystocele (5.7 cm) or the extent of rectal descent (8.1 cm). The ARA at rest and at defecation (135°) differ by less than 10° (Movie 1, http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1).

View larger version (186K): [in a new window]   Figure 2b: Midsagittal spoiled gradient-recalled-echo MR images (22.4/10.7) in an 83-year-old woman with passive fecal incontinence and a history of two vaginal deliveries and hysterectomy, obtained at (a) rest, (b) squeezing, and (c) defecation. The patient was unable to hold the entire enema because of passive fecal incontinence. In a, a moderate cystocele (1; anterior compartment measurement, 5.9 cm) and a large rectal descent (2; posterior compartment measurement, 8.1 cm) are visible. The ARA at rest () is 136°. In b, there is nearly no change in the size of the cystocele (5.6 cm), the extent of rectal descent (8.2 cm), or the ARA (139°). In c, there is nearly no change in the size of the cystocele (5.7 cm) or the extent of rectal descent (8.1 cm). The ARA at rest and at defecation (135°) differ by less than 10° (Movie 1, http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1).

View larger version (155K): [in a new window]   Figure 2c: Midsagittal spoiled gradient-recalled-echo MR images (22.4/10.7) in an 83-year-old woman with passive fecal incontinence and a history of two vaginal deliveries and hysterectomy, obtained at (a) rest, (b) squeezing, and (c) defecation. The patient was unable to hold the entire enema because of passive fecal incontinence. In a, a moderate cystocele (1; anterior compartment measurement, 5.9 cm) and a large rectal descent (2; posterior compartment measurement, 8.1 cm) are visible. The ARA at rest () is 136°. In b, there is nearly no change in the size of the cystocele (5.6 cm), the extent of rectal descent (8.2 cm), or the ARA (139°). In c, there is nearly no change in the size of the cystocele (5.7 cm) or the extent of rectal descent (8.1 cm). The ARA at rest and at defecation (135°) differ by less than 10° (Movie 1, http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1).

View larger version (142K): [in a new window]   Figure 3a: Midsagittal spoiled gradient-recalled-echo MR images (22.2/10.6) in a 55-year-old woman with postdefecation leakage and a history of two vaginal deliveries, obtained in the sitting position at (a) rest and (b) the end of defecation. B = bladder, U = uterus. In a, a moderate anterior proctocele (sagittal diameter, 2.6 cm; arrow) and a large rectal descent (1, measurement for the posterior compartment) are visible. In b, a large anterior proctocele (sagittal diameter, 4.8 cm; white arrow) is present, with incomplete evacuation of the contrast material. In addition, an internal prolapse (black arrow) is visible. The bladder base (1) is located 3.0 cm below the PCL, and the vaginal vault (2) is located 3.6 cm below the PCL; these findings are consistent with a moderate cystocele and moderate vaginal vault descent (Movie 2, http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1).

View larger version (160K): [in a new window]   Figure 3b: Midsagittal spoiled gradient-recalled-echo MR images (22.2/10.6) in a 55-year-old woman with postdefecation leakage and a history of two vaginal deliveries, obtained in the sitting position at (a) rest and (b) the end of defecation. B = bladder, U = uterus. In a, a moderate anterior proctocele (sagittal diameter, 2.6 cm; arrow) and a large rectal descent (1, measurement for the posterior compartment) are visible. In b, a large anterior proctocele (sagittal diameter, 4.8 cm; white arrow) is present, with incomplete evacuation of the contrast material. In addition, an internal prolapse (black arrow) is visible. The bladder base (1) is located 3.0 cm below the PCL, and the vaginal vault (2) is located 3.6 cm below the PCL; these findings are consistent with a moderate cystocele and moderate vaginal vault descent (Movie 2, http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1).

View larger version (163K): [in a new window]   Figure 4: Midsagittal MR image (22.4/10.7) in a 65-year-old woman with postdefecation leakage, urge incontinence, and a history of one vaginal delivery and hysterectomy, obtained at defecation shows a moderate enterocele (*) containing portions of the small and large bowels and leading to outlet obstruction. A large anterior proctocele is visible, with incomplete evacuation of the contrast agent (arrow). A large rectal descent (anorectal junction, 6.7 cm below the PCL) and a small cystocele (bladder [B] base, 1.1 cm below the PCL) are also visible (Movie 3, http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1).

View larger version (146K): [in a new window]   Figure 5: Midsagittal spoiled gradient-recalled-echo MR image (22.2/10.6) in a 60-year-old woman with passive fecal incontinence and a history of two vaginal deliveries, obtained at the end of defecation shows an internal prolapse (arrows) with a moderate anterior proctocele (sagittal diameter, 2.2 cm). Additional findings include a moderate cystocele (bladder base, 4.2 cm below the PCL), a moderate vaginal descent (vaginal vault, 4 cm below the PCL), and a large rectal descent (anorectal junction, 8 cm below the PCL) (Movie 4, http://radiology.rsnajnls.org/cgi/content/full/2402050648/DC1).