Defecography Spots Defects Not Found on Exam.

SCOTTSDALE, ARIZ. -- Approximately 15% of the time that Dr. Dee E. Fenner thinks she knows whether a patient has an enterocele, defecography proves her wrong, she said at a urogynecology conference sponsored by the Mayo Clinic Scottsdale.

In these cases, defecography saves her from searching further for a nonexistent enterocele or from failing to fix one that she thought wasn't there.

Findings from defecography--also called evacuation proctography or pelvic floor evaluation with dynamic fluoroscopy--can be useful in a number of settings, said Dr. Fenner of the University of Washington, Seattle.

In a 1992 study of 74 consecutive patients with constipation, splinting, or straining and a history of pelvic surgery, defecography identified three rectoceles, seven enteroceles, and four sigmoidoceles that were not detected by physical examination, she noted.

In a separate series of 30 women with prolapse greater than stage II, defecography findings altered the planned surgical procedure in 11 cases, she added.

Not every patient heading for surgery to treat pelvic organ prolapse needs defecography. It is indicated in some patients who have had prior pelvic surgery, especially if there's a chance that the surgeon might miss an enterocele. "If you're doing an abdominal sacrocolpopexy, then you're obviously going to fix that enterocele, so you don't need" defecography, she said.

Defecography also is useful when the cause of a patient's complaint cannot be identified during an exam. It can be helpful as well in some cases of chronic constipation or fecal incontinence.