Defecating proctogram
Encyclopedia
The defecating proctogram or defecography is an imaging study performed by a radiologist in which the mechanics of a patient's defecation
are visualized in real time using a fluoroscope.
. The procedure gained popularity at this time in the midst of an outbreak of whipworm
, which is known to cause rectal prolapse
. It has since become the gold standard for diagnosis of any of a number of rectal contractile disorders, including anismus
.
It has since has fallen out of favor due to inadequate training in the technique. It is now only performed at a few institutions. Many radiology residents refer to the procedure as the "Def Proc", "Defogram", or "Stool Finale".
contrast in the vagina while carefully avoiding the rectum. This can often prove to be somewhat challenging, depending on the physique of the individual.
The technique itself involves insertion of a caulk gun device into the rectum with subsequent manual infusion of barium paste until there is adequate distension. The patient is then transferred to a portable plastic commode which is situated next to a flouroscope which records the defecation. Positioning of the x-ray camera is of paramount importance as visualization of the buttocks, rectal vault, and lower pelvis is critical.
More recent techniques involve the use of advanced, cross-sectional imaging modalities such as magnetic resonance imaging
.
Defecation
Defecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
are visualized in real time using a fluoroscope.
History
Defecating proctography was pioneered in 1945 during World War IIWorld War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
. The procedure gained popularity at this time in the midst of an outbreak of whipworm
Whipworm
The human tapworm is a roundworm, which causes trichuriasis when it infects a human large intestine. The name whipworm refers to the shape of the worm; they look like whips with wider "handles" at the posterior end.-Life cycle:The female T. trichiura produces 2,000–10,000 single celled eggs per day...
, which is known to cause rectal prolapse
Rectal prolapse
Rectal prolapse normally describes a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body.-Types:There are three chief conditions which come under the title rectal prolapse:...
. It has since become the gold standard for diagnosis of any of a number of rectal contractile disorders, including anismus
Anismus
Anismus is a malfunction of the external anal sphincter and puborectalis muscle during defecation. Normal defecation involves relaxation of both of these muscles...
.
It has since has fallen out of favor due to inadequate training in the technique. It is now only performed at a few institutions. Many radiology residents refer to the procedure as the "Def Proc", "Defogram", or "Stool Finale".
Technique
In females, pre-procedural preparation involves smearing a small amount of bariumBarium
Barium is a chemical element with the symbol Ba and atomic number 56. It is the fifth element in Group 2, a soft silvery metallic alkaline earth metal. Barium is never found in nature in its pure form due to its reactivity with air. Its oxide is historically known as baryta but it reacts with...
contrast in the vagina while carefully avoiding the rectum. This can often prove to be somewhat challenging, depending on the physique of the individual.
The technique itself involves insertion of a caulk gun device into the rectum with subsequent manual infusion of barium paste until there is adequate distension. The patient is then transferred to a portable plastic commode which is situated next to a flouroscope which records the defecation. Positioning of the x-ray camera is of paramount importance as visualization of the buttocks, rectal vault, and lower pelvis is critical.
More recent techniques involve the use of advanced, cross-sectional imaging modalities such as magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
.