*54-year-old female with difficult defaecation.
What is the most likely diagnosis?
Answer
Answer: Pelvic organ prolapse
Case Discussion:
The dynamic images revealed a moderate degree of global pelvic floor descent, a mild sized anterior rectocoele, and a moderate sized cystocoele. There is an anal mucosal intussusception.
Pelvic organ prolapse, a type of pelvic floor disorder, can affect many women.
Measurements;
Pubococcygeal line – a line joining the inferior aspect of the pubic symphysis to the last coccygeal joint
H line – corresponds to the AP diameter of the hiatus
M line – is the perpendicular distance between the pubococcygeal line and the posterior anorectal junction
Abnormalities to assess;
Rectal descent
Bladder base descent (cystocoele)
Vaginal vault descent
Rectocoele
Intussusception
Peritoneocele
References:
1. Flusberg M, Sahni VA, Erturk SM et-al. Dynamic MR defecography: assessment of the usefulness of the defecation phase. AJR Am J Roentgenol. 2011;196 (4): W394-9.
2. Colaiacomo MC, Masselli G, Polettini E et-al. Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics. 2009;29 (3): e35.