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Tables in Original article by CLAUDIO MORANDI - BEATRICE BREVEGLIERI - CLAUDIO MORATTI - LUCA VERGANTI - PIETRO TORRICELLI

Role of enterocele in obstructed defecation syndrome: proposal of a new radiological and surgical classification

 

Department of Radiology, University of Modena and Reggio Emilia, Italy



(Fig 1)

perineal descent, sigmoidocoele

Fig 1.
- A-F: Female, 20 years old, nulliparous, with a history of significant weight-loss. Association of external prolapse ( p ), perineal descent, sigmoidocele ( s in E and arrow in F ). Rectum ( r ) and small bowel loops ( e ).




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(Fig. 2 )

Sigmoidocoele

Fig 2
. –A-F: Sigmoidocele (s in E and F ). Large anterior rectocele ( arrow in F ). Rectum ( r ) and small bowel loops ( e ).




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(Fig. 3 )

functional enterocoele

Fig 3.
– A-F: Female, 65 years old, with previous hysterectomy and two deliveries. The functional enterocele ( e ) reaches the Pouch of Douglas without compressing the rectum ( r ). The arrow in F shows the intracanalicular prolapse which causes obstructed defecation.




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(Fig. 4 )

non obstructive enterocoele

Fig 4.
– A-F: Female, 49 years old. Non relaxing puborectalis syndrome with indentation of the puborectalis muscle on the posterior wall of the ampulla ( r ) and no significant change in the anorectal angle during defecation. Association of perineal descent, anterior rectocele with barium trapping and non obstructive enterocele that compresses the ampulla without blocking it in the late phase ( D ) of defecation.




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(Fig. 5 )

Non obstructive enterocele

Fig 5.
– A-F: Non obstructive enterocele ( e ) reaches the Pouch of Douglas compressing the rectum ( r ) without obstructing the ampulla. Association with perineal descent and anterior rectocoele.




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(Fig. 6 )

Obstructive enterocele

Fig 6.
– A-F: Female, 65 years old. Obstructive enterocele ( e ) compresses the ampulla ( r ) in the early phase of voiding ( B : C ) and, moving towards the anus, blocks rectal emptying (arrow in F). No evidence of associated functional or anatomical disorders.




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(Fig. 7 )

The ampulla ( r ) is completely compressed by the obstructive enterocele

Fig 7.
– A-F: Female, 55 years old with previous hysterectomy and one delivery. The ampulla ( r ) is completely compressed by the obstructive enterocele ( e and arrow in F ) . No evidence of associated functional or anatomical disorders.




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(Fig. 8 )

Frequency of obstructed defecation in patients

Fig 8.
– Frequency of obstructed defecation in patients with different types of enterocele.




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