Bremmer S, Ahlbäck S O, Udén R, Mellgren A
Department of Diagnostic Radiology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
Dis Colon Rectum. 1995 Sep;38(9):969-73. doi: 10.1007/BF02049734.
A number of physiologic and radiologic investigations are used in investigating defecation disorders. Defecography is one important part of these investigations. However, a correct diagnosis of an enterocele is sometimes difficult despite use of contrast media in the rectum, vagina, and small bowel.
This study was undertaken to ascertain if it was technically possible to perform simultaneous defecography and peritoneography in an effort to improve the diagnostic possibilities in patients with defecation disorders.
Twelve patients with defecation disorders and an unexplained widening of the rectovaginal space at defecography were investigated. Contrast medium was introduced intraperitoneally, after which conventional defecography was performed.
All investigations were carried out without complications and demonstrated the peritoneal outline in all patients. Simultaneous defecography and peritoneography differentiated between an enterocele and a pathologically deep pouch of Douglas--a peritoneocele. Three types of peritoneocele were visualized: vaginal peritoneocele, septal peritoneocele, and rectal peritoneocele with or without enterocele. Combinations of the three types were also found. Eight of the 12 patients had rectal intussusception or rectal prolapse. All of these eight patients had a rectal peritoneocele.
Simultaneous defecography and peritoneography can be performed without technical difficulties or complications. Peritoneal outlines and pouches can, therefore, be studied directly during the act of defecation. An unexplained widening of the rectovaginal space at defecography can be clarified as a peritoneocele, with or without an enterocele. Peritoneocele can be of three different types: rectal, septal, or vaginal.
在排便障碍的研究中会用到多种生理和放射学检查方法。排粪造影是这些检查中的一个重要部分。然而，尽管在直肠、阴道和小肠中使用了造影剂，但有时仍难以正确诊断肠膨出。
本研究旨在确定同时进行排粪造影和腹膜造影在技术上是否可行，以提高排便障碍患者的诊断可能性。
对12例排便障碍且在排粪造影时直肠阴道间隙不明原因增宽的患者进行了研究。先经腹腔注入造影剂，然后进行传统的排粪造影。
所有检查均无并发症发生，且所有患者均显示出腹膜轮廓。同时进行的排粪造影和腹膜造影能够区分肠膨出和病理性的Douglas窝加深——腹膜膨出。观察到三种类型的腹膜膨出：阴道腹膜膨出、间隔腹膜膨出以及伴有或不伴有肠膨出的直肠腹膜膨出。还发现了这三种类型的组合。12例患者中有8例存在直肠套叠或直肠脱垂。这8例患者均有直肠腹膜膨出。
同时进行排粪造影和腹膜造影在技术上没有困难，也不会出现并发症。因此，可以在排便过程中直接研究腹膜轮廓和陷凹。排粪造影时直肠阴道间隙不明原因的增宽可明确为腹膜膨出，伴或不伴有肠膨出。腹膜膨出可分为三种不同类型：直肠型、间隔型或阴道型。
