대한대장항문학회

Purpose : To evaluate the clinical usefulness of defecogrophy in diagnosing the etiology and<br>pathophysiology of constipation. A retrospective study of 56 constipated patients who had no<br>abnormalities in colonoscopy, barium enema and rectal exam were done. Methods : Fifty-six<br>patients (12 men, 44 women) with constipation underwent defecography and 37 of the patients<br>underwent colonic transit studies. Fluoroscopically guided defecography was performed with<br>barium paste introduced into the rectum. Results : Normal defecography finding was observed<br>in thirteen of the 56 patients. Rectocele, spastic levator syndrome (nonrelaxing puborectalis<br>syndrome), sigmoidocele, rectal prolapse, rectal intussusception were observed in 67% (38/56),<br>30% (20/56), 7% (4/56), 5% (3/56) and 2% (1/56) of the patients, respectively. More than one<br>pathological finding was found in 23 (53%) patients. Of the 38 rectoceles, 17 cases were found<br>to be associated with spastic levator syndrome. In solitary rectocele, the anorectal angles at<br>rest, during straining were 92.65 9.08? 108.09 14.35? while 99.85 11.85? 95.90 17.8<br>4? in spastic levator syndrome. In 36 difficult bowel movements, 66% (24/36), 30% (11/36),<br>3% (1/36) were found to have rectocele, spastic levator syndrome, and sigmoidocele,<br>respectively. Normal colonic transit time was observed in twenty six of the 37 patients.<br>Abnormal findings included colonic inertia in 3 (8%) patients, hindgut dysfunction in 4 (11%)<br>patients, and, outlet obstruction in 4 (11%) patients. Of the normal colonic transit time in 26,<br>rectocele in sixteen, rectal prolapse in 1, spastic levator in 2 were observed. Rectoceles were<br>observed in 2 out of 3 colonic inertia, in all 4 hindgut dysfunction, in 1 out of 4 outlet<br>obstruction. Conclusions : Our findings suggest that constipation is often a disorder of<br>defecation rather than an impairment of colonic motility. Defecography should be considered<br>first of all in evaluating the pathophysiology of constipation, especially for whom complaining<br>of difficult bowel.<br>