Abstract
Sixty-nine patients with enterocele on defaecography, and 128 patients without enterocele but with other abnormal findings were investigated to identify concomitant colorectal disorders and their relationship with enterocele. Of the 69 patients with enterocele, 38 (55%) had concomitant rectal intususception and 26 (38%) rectal prolapse. Abnormal physiological findings on anorectal manometry and electrophysiology were more common in patients with enterocele. Previous hysterectomy increased the risk of enterocele formation. The study has demonstrated that patients with enterocele should be investigated thoroughly for other lesions before treatment is planned. Further investigation of the role of enterocele in patients with defaecation disorders is required.
Résumé
Soixante-neuf patients présentant des entérocèles à la défécographie et 128 patients sands entérocèle mais avec d'autres anomalies ont été investigués afin d'identifier les troubles fonctionnels colo-rectaux concomittants et leur relation avec l'entérocèle. De 69 patients avec entérocèle, 38 (55%) présentent simultanément une intussusception et 26 (38%) un prolapsus du rectum. Des anomalies physiologiques lors de manométries et d'investigations électrophysiologiques sont plus fréquentes chez des patients porteurs d'une entérocèle. Une hystérectomie préalable augmente le risque de la formation d'une entérocèle. Cette étude démontre que les patients porteurs d'une entérocèle doivent faire l'objet d'investigations minutieuses pour exclure toute autre lésion avant d'envisager un traitement. Des investigations ultérieures devront être envisagées pour démontrer le rôle de l'entérocèle chez des patients souffrant de troubles de l'exonération.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Kuijpers HC, Bleijenberg G (1990) Assessment and treatment of obstructed defecation. Ann Med 22:405–411
Wexner SD, Daniel N, Jagelman DG (1991) Colectomy for constipation: physiologic investigation is the key to success. Dis Colon Rectum 34:851–856
Ekberg O, Nylander G, Fork FT (1985) Defecography. Radiology 155:45–48
Mellgren A, Bremmer S, Johansson C, Dolk A, Udén R, Ahlbäck S-O, Holmström B (1993) Defecography, results of investigations in 2816 patients. Dis Colon Rectum (in press)
Kelvin FM, Maglinte DD, Hornback JA, Benson JT (1992) Pelvic prolapse: assessment with evacuation proctography (defecography). Radiology 184:547–551
Brodén B, Snellman B (1968) Procidentia of the rectum studied with cineradiography: a contribution to the discussion of causative mechanism. Dis Colon Rectum 11:330–347
Walldén L (1952) Defecation block in cases of deep rectogenital pouch. Acta Chir Scand 165:1–121
Dolk A, Brodén G, Holmström B, Johansson C, Nilsson BY (1990) Slow transit of the colon associated with severe constipation after the Ripstein operation. A clinical and physiologic study. Dis Colon Rectum 33:786–790
Johansson C, Nilsson BY, Holmström B, Dolk A, Mellgren A (1992) Association between rectocele and paradoxical sphincter response. Dis Colon Rectum 35:503–509
Johansson C, Nilsson BY, Mellgren A, Dolk A, Holmström B (1992) Paradoxical sphincter reaction and associated colorectal disorders. Int J Colorect Dis 7:89–94
Holland J (1972) Enterocele and prolapse of the vaginal vault. Clin Obstet Gynecol 15:1145–1154
Addison WA, Livengood C, Sutton GP, Parker RT (1985) Abdominal sacral colpopexy with Mersilene mesh in the retroperitoneal position in the management of posthysterectomy vaginal vault prolapse and enterocele. Am J Obstet Gynecol 153:140–146
Nichols DH, Randall CL (1989) Vaginal Surgery. 3rd edn. Willams & Wilkins, Baltimore
Timmons MC, Addison WA, Addison SB, Cavenar MG (1992) Abdominal sacral colpopexy in 163 women with posthysterectomy vaginal vault prolapse and enterocele. Evolution of operative techniques. J. Reprod Med 37:323–327
Holmström B, Brodén G, Dolk A, Frenckner B (1986) Increased anal resting pressure following the Ripstein operation: a contribution to continency? Dis Colon Rectum 29:486–487
Neill ME, Swash M (1980) Increased motor unit fibre density in the external anal sphincter muscle in anorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 43:343–347
Kiff ES, Swash M (1984) Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 71:614–616
Henry MM, Snooks SJ, Barnes PRH, Swash M (1985) Investigation of disorders of the anorectum and colon. Ann R Coll Surg Engl 67:355–360
Perey JP, Neill ME, Kandiah TK, Swash M (1982) A neurogenic factor in faecal incontinence in the elderly. Age Ageing 11:175–179
Hinton JM, Lennard-Jones JE, Young AC (1969) A new method for studying gut transit time using radioopaque markers. Gut 10:842–847
Keighley MRB, Shouler PJ (1984) Abnormalities of colonic function in patients with rectal prolapse and fecal incontinence. Br J Surg 71:892–895
Ranney B (1981) Enterocele, vaginal prolapse, pelvic hernia: recognition and treatment. Am J Obstet Gynecol 140:53–61
Cruikshank SH (1987) Preventing posthysterectomy vaginal vault prolapse and enterocele during vaginal hysterectomy. Am J Obstet Gynecol 156:1433–1440
Smith P (1993) Estrogens and the urogenital tract. Acta Obstet Gynecol Scand 72:1–26
Ahlbäck S-O, Brodén B (1978) Defecography in invagination and prolapse of the rectum. Läkartidningen 75:668–673 (in Swedish)
Symmonds RE, Williams TJ, Lee RA and Webb MJ (1981) Posthysterectomy enterocele and vaginal vault prolapse. Am J Obstet Gynecol 140:852–859
Nichols D (1972) Types of enterocele and principles underlying choice of operation for repair. Am J Obstet Gynecol 40:257–263
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mellgren, A., Johansson, C., Dolk, A. et al. Enterocele demonstrated by defaecography is associated with other pelvic floor disorders. Int J Colorect Dis 9, 121–124 (1994). https://doi.org/10.1007/BF00290186
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00290186