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Query: UMLS:C0021933 (intussusception)
 3,822 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 90 patients with intussusception of the rectum (internal procidentia) has been studied. In 11 per cent of the patients there was also an enterocele and in 3 per cent, a large proctocele. Forty patients were operated upon by the Ripstein procedure. Indications for operation were, in most cases, incontinence for gas and/or feces. Seventy-five per cent of the preoperatively incontinent patients were, at follow-up 2 to 10 years after operation, continent. When indications for surgery were pain and or a sensation of obstruction, the results were poor; most of these patients had unchanged symptoms postoperatively, and some even had increased symptoms. There was one postoperative death. Of 50 patients treated conservatively during a period of 2 to 10 years, only two had to be operated upon: one due to the development of a rectal prolapse and the other due to severe pain and an increased sensation of obstruction.
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PMID:Intussusception of the rectum-internal procidentia: treatment and results in 90 patients. 114 81

The contribution of evacuation proctography (EP) to the evaluation of pelvic prolapse was assessed in 74 consecutive patients. A rectocele was demonstrated in 73 patients (99%); large rectoceles frequently showed barium trapping, but there was no correlation between these findings and rectal symptoms. An enterocele was detected at evacuation proctography in 13 patients (18%) (including two enteroceles seen only retrospectively), and a sigmoidocele was shown in four patients (5%). Physical examination resulted in detection of only seven enteroceles and of none of the sigmoidoceles. In 48 patients (65%), additional findings were evident at EP, including excessive pelvic floor descent, anal incontinence, rectal intussusception, and spastic pelvic floor. These data suggest that EP is particularly useful in the preoperative evaluation of pelvic prolapse if the patient has anorectal symptoms or is at risk for an enterocele. EP contributes to surgical planning by enabling identification of clinically unsuspected enteroceles and sigmoidoceles and coexistent disorders of rectal evacuation.
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PMID:Pelvic prolapse: assessment with evacuation proctography (defecography) 843 Feb 10

Defecography is a technique of examining the rectum and anal canal in which the patient is studied while sitting down rather than recumbent and recordings are obtained both at rest and during straining. The authors describe their findings in 83 patients with dyschezia. Defecation was normal in 28 patients. Prolapse of the anal mucosa was seen in 13 patients and internal procidentia in 23, 12 of whom also had intussusception manifested as rectal prolapse. A deep rectogenital fossa associated with an enterocele was seen in 16 patients; 13 had a proctocele, while fecal retention was seen in 5. Descent of the pelvic floor and changes in the angle between the rectum and anal canal were assessed. The authors recommend defecography as a more physiological means of assessing rectal dysfunction.
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PMID:Defecography. 397 18

Dynamic rectal examination (DRE), first described in 1952, is becoming more widely used in the dynamic evaluation of pelvic floor and anorectal motility disorders. It is a minimally invasive investigation which is well tolerated by patients and provides information about the anosphincteric, puborectal and levator muscle in addition to insight in rectal function and structure. DRE is the only investigation of anorectal function that can give detailed anatomical information such as the presence of a rectocele, an enterocele and an intussusception. DRE should be performed in a quiet environment with a minimum number of investigators present. Any technique which attempts to study the defecatory mechanism must be a compromise since the patient is aware of being studied. In order to defecate on command the radiologist must make the patient comfortable before starting the investigative procedures to avoid any possible psychological inhibition. We have not encountered any failures in this regard. The relative value of the radiological findings with respect to symptoms and complaints is insufficiently known. This has been the main incentive to design carefully and carry out a large prospective critical evaluation of various aspects of DRE in particular the correlation with objective findings and symptoms. Moreover an assessment has been made of its overall clinical utility (Wiersma, 1994). It is very likely that DRE is both investigator- and technique-dependent. To ensure that the study is as physiological as possible the contrast medium used to fill the rectum needs to be semi-solid and malleable equivalent in consistency to a normal faecal bolus. For proper anatomical studies in females vaginal opacification is mandatory. The acceptance of vaginal contrast was good. Only 4% of the female patients preferred not to have the vaginal application of contrast. The technique of DRE when performed with small bowel and vaginal opacification provides a sensitive and objective method of detecting enteroceles. A substantial number of female patients related the onset of their complaints to hysterectomy. In female patients with constipation there was a significantly higher incidence of enteroceles in patients with a hysterectomy compared to the group of females without hysterectomy. Because of these findings a series of pre- and postoperative DREs in hysterectomy patients are on their way in our institute. Unlike a rectocele which is usually most obvious during defecation, enteroceles are sometimes appreciated only with repeated straining after evacuation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Dynamic rectal examination (defecography). 774 73

In the past decade, interest in the anorectal region and the mechanism of continence and defecation has been increasing. Subsequently, techniques to visualize the anorectum have been introduced; evacuation proctography and defecography have been used to describe the dynamic radiologic evaluation of this area. Also, developments in anorectal manometry, electromyography, and transrectal sonography have renewed interest in defecography, particularly in categorizing the functional disorders including rectocele, intussusception and prolapse, enterocele, descending perineum syndrome, dyskinetic puborectalis muscle, solitary rectal ulcer syndrome, and incontinence.
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PMID:Functional disorders of the anus and rectum: findings on defecography. 845 64

Defaecation disorders may be subsumed in three categories: Inability to control motions = incontinence. Difficulty of evacuation = constipation [inertia coli, outlet obstruction]. Impeded defaecation: Rectocele, enterocele, intussusception. Etiology, examination and therapy are described in detail. Characteristic complaints of patients are listed and matched with probable diagnoses. Beside routine proctologic examination endosonography, estimation of transit time, endoscopy and defecography are discussed. The role of nutrition is stressed and emphasis layed on fibre and fluid intake. The advice, "take more fluid and fibres" does not help a lot, because no individual help is given. A time consuming nutrition and defaecation history has to be taken to establish nutritional support. This attention gives confidence to the patient and helps a great deal in the treatment. A checklist of the therapy of constipation and summarizing tables on different types of fibres are included. Additional conservative treatments are pelvic exercises and biofeedback training. Operative therapy is directed towards etiology of the disorder. Therefore many different methods exist and their diagnose related indication are discussed.
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PMID:[Defecation problems: incontinence, constipation and impeded defecation; why and what can be done?]. 922 39

REPORT STUDY: Defaecography reports from 2816 patients were evaluated. Twenty-three percent of the investigations were considered normal, 31% showed rectal intussusception, 13% rectal prolapse, 27% rectocele, and 19% enterocele. A standardised protocol is suggested to ensure a complete evaluation of defaecography. One hundred and ten reports were unclear and reviewed. The unclear reports usually concerned an unexplained widening of the rectovaginal space, and gave incitement to further studies. TECHNIQUE STUDY: Twelve patients with an unexplained widening of the rectovaginal space at defaecography were investigated using defaecography and peritoneography simultaneously, by us named defaeco-peritoneography. All investigations were carried out without complications. Defaeco-peritoneography proved the unexplained widening to be an extension of the pouch of Douglas, a peritoneocele. UNEXPLAINED WIDENING STUDY: Twenty-two patients with unexplained widening of the rectovaginal space noted at defaecography were studied using defaeco-peritoneography. The outline and movements of the peritoneum in the pelvic cavity could be visualised during the dynamic act of defaecation. The unexplained widening of the rectovaginal space was caused completely by a peritoneocele in 14 patients, partially in 6 patients and 2 remained unexplained. However, only 9 out of 22 widenings were peritoneoceles with an enterocele. Just 11 peritoneoceles only contained fluid. Three types of peritoneocele were demonstrated: vaginal, septal, and rectal, with or without enterocele. Combinations of these were also found. RECTAL INTUSSUSCEPTION STUDY: Fifty-seven patients with defaecation disorders were examined using defaeco-peritoneography. Twenty-three patients had rectal intussusception and 7 patients had a rectal prolapse. All these patients had a rectal peritoneocele in the serosal ring-pocket of the rectal intussusception or in the rectal prolapse. Twenty-seven patients had neither rectal intussusception nor rectal prolapse and none of these patients had a rectal peritoneocele. DAILY LIFE STUDY: Twenty-six female patients showing peritoneocele without a contrast-filled rectum at start at defaeco-peritoneography were investigated; 13 of them had enteroceles. Spot radiographs before and after filling the rectum with contrast medium were compared. The peritoneocele disappeared completely in 19 of the patients and was reduced in size in the remaining 7, and the enterocele disappeared completely when the rectum was distended. Defaeco-peritoneography should therefore include a radiograph before the rectum is filled, as it shows the habitual (daily life) anatomy and can disclose pathology as peritoneocele and enterocele. TRANSFORMATION STUDY: Forty-six patients with peritoneocele at defaeco-peritoneography were studied at three different stages during rectal evacuation. At start with contrast-filled rectum, 14 patients had a peritoneocele, and 32 were regarded as normal. At maximum straining, all patients had a peritoneocele and 20 of these were still present after rectal evacuation. The peritoneoceles were largest at straining and rectal types were most common. No enterocele was seen at start. At maximum straining, 21 patients developed an enterocele.
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PMID:Peritoneocele. A radiological study with defaeco-peritoneography. 948 4

Fifty-nine evacuating proctograms were performed over a 4 month period. We sought to identify how useful this technique is in diagnosing the cause of various anorectal symptoms and indicating which treatment option may be beneficial to the patient. The main reasons for referral were faecal soiling (60%) and obstructed defaecation (47%). Of the proctograms, 90% revealed some pathology. The most common abnormalities detected were rectocele (56%), rectal intussusception (39%), enterocele (19%) and rectal prolapse (12%). Of the patients, 45% were treated with an operation specific to the pathology detected on the proctogram; 29% did not require any active treatment and the remainder were managed with biofeedback conditioning or injection sclerotherapy. Evacuating proctography is of value in providing a diagnosis in patients with anorectal symptoms and thereby allowing specific treatment, operative or nonoperative, to be directed to the underlying pathology.
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PMID:A prospective audit of the usefulness of evacuating proctography. 957 26

Obstructive defecation is observed in approximately half of all patients with functional constipation. Functional constipation has been related to alterations in intestinal motility (slow transit constipation) and to pelvic floor disorders leading to obstructive defecation associated with anatomical alterations of the pelvic floor (rectocele, posterior perineal hernia, enterocele and sigmoidocele, internal rectal intussusception, occult mucosal prolapse, solitary rectal ulcer and descending perineum syndrome), or obstructive defecation without anatomical alterations (pelvic floor dyssynergy or anismus). The diagnostic methods used (history and physical examination, colonic transit time, balloon expulsion test, proctography, anorectal manometry and electromyography) are reviewed. Conservative medical treatment and the indications for surgical treatment and its results are also discussed.
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PMID:[Obstructive defecation. Diagnostic methods and treatment]. 1647 17

Anterior rectocele and rectoanal intussusception are anatomic disorders related to excessive straining during defecation that usually manifest with symptoms of obstructive defecation. Stapled transanal rectal resection (STARR), a newly described surgical method for correcting these disorders, is considered a good alternative to the traditional transrectal approaches. The aim of the present study was to assess the early postoperative functional results of STARR. A total of 16 patients (13 female) were subjected to the STARR procedure during a period of 12 months. The presence of anatomic disorders of the anorectum was verified by dynamic defecography. Preoperative assessment also included colonic transit time, anal sphincter ultrasonography, and anorectal stationary manometry. Postoperative assessment included the same battery of tests. Altogether, 12 patients had rectoanal intussusception of > 2 cm and rectocele. In eight of them the anterior component of the rectocele was 2 to 4 cm, and in four it was > 4 cm. Four patients had a 1- to 2-cm internal intussusception and a rectocele of < 2 cm. All of them reported evacuation difficulties, but none had significant incontinence. Preoperative endoscopy did not reveal the presence of a solitary ulcer in any of the patients. All females had had normal vaginal deliveries, and four of them were multiparous. No complications were encountered postoperatively, and the need for analgesics was minimal. At defecography, rectoanal anatomy was seen to be restored in all patients. Obstructive defecation symptoms remained rather unaffected in seven, disappeared in three, and improved significantly in the remaining six patients. The seven failures showed anismus at manometry and had biofeedback treatment with satisfactory results in five of them. Failure of the operation and biofeedback sessions to treat symptoms in those two cases was attributed to coexisting enterocele, which had been missed preoperatively. Immediately after surgery, most of the patients complained of urgency and frequent small motions that resolved spontaneously within 3 to 5 weeks in all but two cases. STARR is a safe, well tolerated surgical procedure that effectively restores anatomy and function of the anorectum in patients with anterior mucosal prolapse and rectoanal intussusception. Additional biofeedback treatment is usually necessary for further functional improvement. Failure may be the result of other coexisting anatomic and functional abnormalities of the pelvic floor.
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PMID:Stapled transanal rectal resection (STARR) to reverse the anatomic disorders of pelvic floor dyssynergia. 1745 42


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