Peritoneocele. A radiological study with defaeco-peritoneography.

Abstract

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.