DÄ internationalArchive46/2009The Pathophysiology, Diagnosis and Treatment of Constipation: Obsolescence of X-ray Defecography

Correspondence

The Pathophysiology, Diagnosis and Treatment of Constipation: Obsolescence of X-ray Defecography

Dtsch Arztebl Int 2009; 106(46): 765. DOI: 10.3238/arztebl.2009.0765a

Holsteg, K; Stehling, M

LNSLNS Müller-Lissner in his article mentions conventional x-ray defecography as the imaging procedure of choice in the diagnosis of defecation disorders.

This procedure is obsolete, owing to its radiation exposure and its limited validity. Dynamic magnetic resonance imaging (MRI) of the pelvic floor, which is unfortunately not mentioned at all, can be conducted speedily and simply. It does not entail exposure to ionizing radiation and is better tolerated by patients. The reason is that the investigators are outside the room where the patient is lying in the scanner and evacuates into diapers. It was shown years ago that analyzing defecation while the patient is lying down is equivalent to analyzing it while the patient is sitting up (2).

Since defecation disorders are often complex dysfunctions of the pelvic floor, a further advantage lies in the fact that by using MRI, the bladder, urethra, vagina, and uterus can be imaged during one examination, without the need for any further invasive procedures or for contrast medium (1).

MRI also enables the representation of complications such as enterocele or sigmoidocele. High resolution imaging of the pelvic floor structures allows for assessment of atrophies and scarring of the levator sling as well as the fascia and ligaments of the pelvic floor (3).
DOI: 10.3238/arztebl.2009.0765a

Dr. med. Kirsten Holsteg
Prof. Dr. med. Michael Stehling
Institut für Bildgebende Diagnostik
Strahlenberger Str. 110 – AlphaHaus
63067 Frankfurt am Main/Offenbach, Germany
holsteg@bilddiagnostik.de


Conflict of interest statement
The authors declare that no conflict of interest exists according to the Guidelines of the International Committee of Medical Journal Editors.
1.
Healy JC, et al.: Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR 1997; 169: 775–9. MEDLINE
2.
Fielding JR, et al.: MR imaging of pelvic floor continence mechanisms in the supine and sitting postitions. AJR 1998; 171: 1607–10. MEDLINE
3.
Law YM, et al.: MRI of pelvic floor dysfunction: review. AJR 2008; 191: 45–53. MEDLINE
4.
Müller-Lissner S: The pathophysiology, diagnosis and treatment of constipation [Obstipation – Pathophysiologie, Diagnose und Therapie]. Dtsch Arztebl Int 2009; 106(25): 424–32. MEDLINE
1. Healy JC, et al.: Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR 1997; 169: 775–9. MEDLINE
2. Fielding JR, et al.: MR imaging of pelvic floor continence mechanisms in the supine and sitting postitions. AJR 1998; 171: 1607–10. MEDLINE
3. Law YM, et al.: MRI of pelvic floor dysfunction: review. AJR 2008; 191: 45–53. MEDLINE
4. Müller-Lissner S: The pathophysiology, diagnosis and treatment of constipation [Obstipation – Pathophysiologie, Diagnose und Therapie]. Dtsch Arztebl Int 2009; 106(25): 424–32. MEDLINE