syb: defecogram by borko kereshi, msiii. the case 32 year old female with a history of: – chronic...
TRANSCRIPT
![Page 1: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/1.jpg)
SYB: Defecogram
By Borko Kereshi, MSIII
![Page 2: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/2.jpg)
The Case
• 32 year old female with a history of:– Chronic constipation– Straining– Irritable Bowel Syndrome
![Page 3: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/3.jpg)
Defecogram: The Technique
• Approximately 1 hour before the study the patient ingests one bottle of thin barium to visualize the small bowel for possible enterocele.
• Barium paste is instilled into the rectum. • A small metallic marker is placed on the skin
near the anus. • The patient is imaged in the lateral projection
during the following maneuvers…
![Page 4: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/4.jpg)
The 7 Steps of a Defecogram
• 1: Rest• 2: Cough• 3: Squeeze• 4: Valsalva• 5: Evacuation• 6: Post-evacuation valsalva• 7: Post-evacuation rest
![Page 5: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/5.jpg)
Rest
![Page 6: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/6.jpg)
Cough
no incontinence during coughing
![Page 7: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/7.jpg)
Squeeze
appropriate motion of the anorectal angle during the squeeze
![Page 8: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/8.jpg)
Valsalva
appropriate motion of the anorectal angle during the valsalva maneuver
![Page 9: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/9.jpg)
Evacuation
![Page 10: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/10.jpg)
Evacuation
Any abnormalities noted?
![Page 11: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/11.jpg)
Evacuation
Any abnormalities noted?
![Page 12: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/12.jpg)
Anterior Rectocele
![Page 13: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/13.jpg)
Evacuation
Any other abnormalities noted?
![Page 14: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/14.jpg)
Evacuation
![Page 15: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/15.jpg)
Puborectalis Dyskinesia
• contraction of the puborectalis during evacuation (left arrow in preceding image)
• Additionally, there is contraction of the anal sphincter during evacuation consistent with sphincter dyskinesia (right arrow)
![Page 16: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/16.jpg)
![Page 17: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/17.jpg)
Post-evacuation valsalva
![Page 18: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/18.jpg)
Post-evacuation rest
Small post void residual
![Page 19: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/19.jpg)
• The patient required multiple efforts of Valsalva and squeeze to evacuate the barium.
• This impaired contraction is highly predictive of anismus– Anismus: malfunction of the external anal
sphincter and puborectalis muscle during defecation
– More common in women– Sometimes associated with sexual abuse
![Page 20: SYB: Defecogram By Borko Kereshi, MSIII. The Case 32 year old female with a history of: – Chronic constipation – Straining – Irritable Bowel Syndrome](https://reader036.vdocuments.us/reader036/viewer/2022062722/56649f285503460f94c3ff88/html5/thumbnails/20.jpg)
References
• LEROI A.-M. ; BERKELMANS I. ; DENIS P. ; HEMOND M. ; DEVROEDE G. Anismus as marker of sexual abuse : consequences of abuse on anorectal motility. Digestive diseases and sciences. ISSN 0163-2116. vol. 40, no7, pp. 1411-1416, 1995
• healthlibrary.epnet.com• www.aboutincontinence.org