Rectocele

Author(s)

Belo-Oliveira Pedro, Rodrigues Henrique, Belo-Soares Pedro, Ilharco José

Patient

female, 45 year(s)

Clinical Summary

A 45-year-old female patient presented with symptoms of obstructed defecation.

Clinical History and Imaging Procedures

A 45-year-old female presented with symptoms of obstructed defecation and the need to press the posterior wall of the vagina and to use rectal digitation in order to assist defecation . At our department, a defecography was performed and the results showed an anterior rectocele associated with a poor aperture of the anorectal angle. There was a retention of barium in the rectocele at the end of evacuation.

Discussion

A rectocele is a herniation of the rectal wall, with a higher prevalence of the occurrence of an anterior rectocele than a posterior rectocele. This condition is more common in women, and factors such as multiparity and traumatic vaginal deliveries, which cause a weakness of the rectovaginal septum, are usually implicated. Some rectoceles may be caused by failure or relaxation or paradoxical contraction of the puborectalis muscle occurring during attempted evacuation. The rectoceles are measured by tracing the distance from the anterior rectal wall to a line passing through the anterior portion of the anal canal. If it is less than 2 cm, the rectoceles are accepted as normal findings, whereas those measuring more than 2 cm can cause outlet obstruction and rectal emptying difficulties. Rectoceles may cause mild to severe anorectal symptoms that are usually associated with chronic constipation. It is probable that straining aggravates the rectocele, enlarges it, and makes the evacuation even more difficult. In patients with rectocele and paradoxical sphincter reaction, defecation has to occur through the unrelaxed pelvic floor. The initial phase of management usually involves a high residue diet to try to elicit rectal voiding. The next step is to use increasing doses of laxatives and enemas. Neither procedure is effective in solving the problem. There is a wide variety of surgical approaches with the aim of assuring rectal emptying by reducing the dimension of the rectocele. However, the results of operation are often disappointing with regard to emptying difficulties. Surgical repair-either vaginal, transperineal or transanal-does not always alleviate the symptoms.

Final Diagnosis

Rectocele.

MeSH

  1. Rectocele [C06.405.469.860.810]
    A hernial protrusion of part of the rectum into the vagina. (Dorland, 28th ed)

References

  1. [1]

Greenberg T, Kelvin FM, Maglinte DD. Barium trapping in rectoceles: are we trapped by the wrong definition? Abdom Imaging. 2001 Nov-Dec;26(6):587-90.

  1. [2]

Ayabaca SM, Zbar AP, Pescatori M. Anal continence after rectocele repair. Dis Colon Rectum. 2002 Jan;45(1):63-9.

  1. [3]

van Dam JH, Ginai AZ, Gosselink MJ, Huisman WM, Bonjer HJ, Hop WC, Schouten WR. Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum. 1997 Feb;40(2):201-7.

Citation

Belo-Oliveira Pedro, Rodrigues Henrique, Belo-Soares Pedro, Ilharco José (2005, May 15).

Rectocele, {Online}.

URL:

DOI: 10.1594/EURORAD/CASE.3072

To top

  • Published 15.05.2005
  • DOI 10.1594/EURORAD/CASE.3072
  • SectionGastro-Intestinal Imaging
  • Case-TypeClinical Case
  • Difficulty Student
  • Views 67
  • Language(s)
  • Figure 1

Defecography-spot film during straining

A spot film during straining showing an anterior rectocele and a poor aperture of the anorectal angle (indicated by an arrow). The rectocele is measured by defining the distance between the anterior rectal wall and a line traced through the...

  • Figure 2

Defecography-spot film after evacuation

A defecography-spot film after evacuation, showing the retention of barium in the anterior rectocele.

Figure 1

Defecography-spot film during straining

A spot film during straining showing an anterior rectocele and a poor aperture of the anorectal angle (indicated by an arrow). The rectocele is measured by defining the distance between the anterior rectal wall and a line traced through the anterior portion of the anal canal (red line). If this distance is more than 2 cm we are able to diagnose a rectocele.

Figure 2

Defecography-spot film after evacuation

A defecography-spot film after evacuation, showing the retention of barium in the anterior rectocele.

To top

HomeSearchHistoryFAQContactDisclaimerImprint