The Use of Defecography to Identify Symptomatic Enteroceles
Alexandriah Alas, Shellee Ogawa, Benjamin Basseri, Karyn Eilber, John Bray, Jeffrey Conklin, Mark Pimentel, Jennifer T. Anger
Cleveland Clinic Florida and Cedars-Sinai Medical Center
The classic enterocele that occurs in the setting of apical vaginal prolapse is usually asymptomatic. However, when enteroceles occur between the posterior vaginal wall and rectum (in the setting of good apical support), they can be associated with significant defecatory dysfunction. In fact, straining can be so severe that rectal prolapse develops.
Our primary objective was to identify enterocele symptoms that lead to defecography.
Our secondary objective was to differentiate enteroceles from other pelvic floor disorders that can cause defecatory dysfunction.
Materials and Methods
•Retrospective chart review
•Inclusion: women undergoing defecographic studies
•The electronic medical record was reviewed for presenting symptoms, physical exam findings, and defecography results.
•Statistics calculated included Pearson Chi-squared test for categorical data, and student t-tests for continuous variables.
•A total of 144 women underwent defecography
•38 had an enterocele
•64 had a rectocele
•39 had rectal prolapse or intussusception
•60 had pelvic floor dysfunction (PFD)
•The average age was 56.3±11.5
•Symptoms of an enterocele:
•Constipation (68.4%), sensation of fullness or pressure (78.9%), incomplete evacuation of bowels (26.3%)
•There was no difference in symptoms between enteroceles, rectoceles and PFD (Table 1).
•There were significantly fewer subjects complaining of a sensation of fullness or pressure in the rectal prolapse group versus the enterocele group, (p=0.00002).
•Concomitant pelvic floor disorders identified with an enterocele
•Rectocele n=14 (36.8%), rectal prolapse n=13 (34.2%), FPD n=5 (13.2%), and fecal incontinence n=17 (44.7%).
•The most common presenting symptoms for a combination
•Enterocele/rectocele : sensation of fullness or pressure (92.9%)
•Enterocele/rectal prolapse: sensation of fullness or pressure (100%)
•Our cohort demonstrated that symptoms for pelvic floor disorders could appear similar and that some women with complaints suggestive of a rectocele only have an enterocele, which may be difficult to diagnose clinically or on exam alone.
•Women with complaints suggestive of a rectocele but a negative exam, would likely benefit from defecography studies to identify an enterocele.