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Titre du document / Document title

Diagnosis and assessment of sigmoidoceles. Discussion

Auteur(s) / Author(s)

FENNER D. E. (1) ; HALES D. (Commentateur) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Obstetrics and Gynecology, Rush-Presbyterian-St. Luke's Medical Center, ETATS-UNIS

Résumé / Abstract

OBJECTIVE: This study analyzed the clinical presentation, incidence, characteristics as demonstrated by defecating proctography, and surgical outcomes of sigmoidoceles. STUDY DESIGN: Defecating proctograms were obtained on all women with clinical evidence of pelvic floor defects between June 1, 1991, and June 30, 1995. The proctograms were retrospectively reviewed for the presence of a sigmoidocele and concomitant pelvic hernias. The distance between the maximum point of sigmoid descent with strain and the perineal body was measured. A chart review was performed to obtain clinical history, physical examination results, surgical treatment, and outcome. RESULTS: Nine sigmoidoceles (4.0%) were noted in 234 defecating proctograms. The leading edge of the sigmoid hernia ranged from 3.8 cm beyond the perineal body to 8 cm above the perineal body. All nine patients were found to have concomitant rectoceles by proctography, whereas only three were found to have enteroceles. Physical examination before proctography suggested that six patients had vaginal vault prolapse with enterocele, one patient had uterine prolapse with enterocele, and two patients had rectoceles alone. Five of the seven patients clinically diagnosed with an enterocele showed no small bowel herniation on defecography. No sigmoidoceles were suspected by physical diagnosis alone. All rectoceles were diagnosed by clinical examination. All patients except one, who had concomitant rectal prolapse, complained of constipation. Two patients required manual pressure to the perineum or vagina to defecate. Seven of the nine patients underwent pelvic reconstructive surgery. The surgical procedure for sigmoidocele was determined by severity of constipation, degree of prolapse, and sigmoid redundancy at the time of surgery. Two patients underwent sigmoid resection with sigmoidopexy, one patient had sigmoidopexy alone, and four patients had Halban obliteration of the cul-de-sac. Two patients are successfully using pessaries. Follow-up from 4 months to 2 years (mean 12 months) showed no recurrence of an apical defect by clinical examination. One patient had a recurrent rectocele to the hymenal ring with strain. Five patients had no complaints of constipation, whereas two noted improvement but continued symptoms. Both these patients had Halban procedures only, and one had the recurrent rectocele. CONCLUSIONS: Sigmoidoceles are an uncommon but not rare finding with apical support defects. Physical examination alone does not make the diagnosis. All patients had a rectocele, which substantiates a posterior vaginal support defect. In these patients there was a strong association with constipation that responded to surgical correction, but the degree of anatomic distortion did not always correlate with functional impairment.

Revue / Journal Title

American journal of obstetrics and gynecology    ISSN  0002-9378   CODEN AJOGAH 

Source / Source

Congrès
Annual Meeting of the Society of Gynecologic Surgeons No22, Albuquerque, New Mexico , ETATS-UNIS (04/03/1996)
1996, vol. 175, no 6, pp. 1414-1492 (8 ref.), pp. 1438-1442

Langue / Language

Anglais

Editeur / Publisher

Elsevier, New York, NY, ETATS-UNIS  (1920) (Revue)

Mots-clés anglais / English Keywords

Prolapsus

;

Pelvic colon

;

Diagnosis

;

Defecation

;

Surgery

;

Prognosis

;

Treatment

;

Female

;

Human

;

Colonic disease

;

Digestive diseases

;

Radiodiagnosis

;

Mots-clés français / French Keywords

Prolapsus

;

Côlon sigmoïde

;

Diagnostic

;

Défécation

;

Chirurgie

;

Pronostic

;

Traitement

;

Femelle

;

Homme

;

Proctographie

;

Rectocèle

;

Côlon pathologie

;

Appareil digestif pathologie

;

Radiodiagnostic

;

Mots-clés espagnols / Spanish Keywords

Prolapsus

;

Colón sigmoideo

;

Diagnóstico

;

Defecación

;

Cirugía

;

Pronóstico

;

Tratamiento

;

Hembra

;

Hombre

;

Colón patología

;

Aparato digestivo patología

;

Radiodiagnóstico

;

Localisation / Location

INIST-CNRS, Cote INIST : 3053, 35400006124847.0040

Nº notice refdoc (ud4) : 2537395



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