MRI DEFECOGRAM
Protocol:
Dynamic imaging of pelvic floor was done in sagittal plane using T2W sequences during rest, squeezing, straining and defecation.
OBSERVATIONS:
Pelvic floor imaging:
At rest: The anorectal junction is abnormally low (9 mms below the pubo- coccygeal line). Anal sphincter is close.
Ano-rectal angle measures 100.
No evidence of rectocele is noted at rest. Cervix is seen ~ 0.8cms below the PCL.
The positions of the bladder base noted above the pubo- coccygeal line.
During squeezing: The ano-rectal angle fails to close and angle remains obtuse. The anorectal junction and cervix remains abnormally low.
During straining: Further descent of the rectum noted (~25mm below the pubo-coccygeal line) with increase in the anorectal angle (105 degrees). There is descent of the urinary bladder for ~ 8mm from the PCL.
There is further increase in the cervical descent by ~ 2.5cms.
During defecation: There is further descent of anorectal junction (~4.5 cms from PCL). There is interval appearance of the rectocele and it measures 1.9cms. There is descent of the urinary bladder for ~3.0cms and cervix by ~4.7 cms from the PCL. Small cystocele seen.
No obvious enterocele. Both levator ani are thin/atrophic.
IMPRESSION: MR Defecogram Study reveals:
Mild Pelvic floor descent of anterior /middle compartment and moderate descent of the posterior compartment with small anterior rectocele and cystocele.