It is a test to look inside your muscles and organs while poop with the help of a fluoroscopy machine or an MRI It's a study of your body mechanism when the patient poop

1. DEFECOGRAPHY
ANANYA GIRISH BABU
LECTURE RADIOLOGY

2. OBJECTIVES
• Introduction
• Indication
• Techniques
• Contraindication

3. INTRODUCTION
• It is a study of your body mechanics when the patient poop.
• X rays [fluoroscopic] or MRI imaging is commonly used for the muscles
and organs in action to help determining the cause of pooping disorders
such as incontinence and constipation
• Simply it is a test to look inside your muscles and organs while poop or
defecate , which help the healthcare peoples to get detailed imaging
how the muscles and organs moves when poop
• If the patient having trouble pooping or holding poop or other kind of
difficulties Docters recommend defecography

4. • Defecography is performed by instilling thickened
barium into the rectum. With the patient sitting on a
radiolucent commode, films or videos are taken
during fluoroscopy with the patient resting, deferring
defecation, and straining to defecate. This procedure
evaluates the rate and completeness of rectal
emptying, anorectal angle, and amount of perineal
descent.

6. INDICATION
• Constipation-- Defecography was initially developed to assess
patients with complaints of constipation and a sensation of rectal
outlet obstruction
• Suspected Enterocele or Rectocele (Obstructed Defecation) - Patients
with symptoms of enterocele or rectocele describe prolonged
straining at defecation, with a sensation of partial or complete
blockage (frequently a “closed trapdoor” preventing passage of
stool)
• Incomplete Emptying Incomplete emptying refers to a sensation of
stool retained in the rectum after defecation, coupled with an
immediate need to empty again or a need for digital manipulation
in order to attempt complete evacuation

7. • Rectal Intussusception or Prolapse Internal prolapse or
intussusception may be difficult or impossible to diagnose
without defecography
• Pain with Defecation
• Faecal Incontinence
• Faecal Incontinence

8. CONTRAINDICATION
• Postoperative rectum
• Pregnancy
• Allergic to contrast media
CONTRAST MEDIUM
Options for rectal contrast preparations include barium
suspension, mixtures of barium and starch (oatmeal, potato flakes),
and commercial products formulated specifically for defecography

9. TECHNIQUE
• In females, pre-procedural preparation involves smearing a small
amount of barium contrast agent in the vagina, which will help
to identify if anterior rectocele, enterocele or sigmoidocele is
present.
• The technique itself involves the insertion of a caulking
gun device into the rectum with a 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 fluoroscope 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.

10. FILMING AND POSITION
• Once contrast is inserted, spot films may be taken either with the patient
lying in the lateral decubitis position or sitting on a special radiolucent
commode. The pelvis and opacified rectum are filmed while the patient
is instructed to rest, squeeze, strain, and cough. The films permit
measurement of perineal descent with straining, changes in the
anorectal angle, and changes in anal canal length.
• Lateral radiographs of the pelvis produce glare in the area of the anal
canal, due to the difference in radiolucency between air and the pelvis.
• Commodes used for defecography are designed to reduce the variation
by employing a filtration device to absorb radiation below the seat and
buttocks.

11. • patient is first in left lateral decubitus position
1. 2-4 x 60 mL of thick barium paste is introduced into the rectum with a large bore soft catheter
(Miller catheter) and the 60 mL syringes
2. barium may be mixed with breadcrumbs, cornflour or porridge powder to form a solution with
stool-like consistency (neostool)
3. if the patient has an urge to defecate, the instillation of contrast can cease
• spot lateral images of the patient at rest in the left lateral decubitus position
1. knees are drawn up in this position, as if the patient were sitting
• patient is positioned on the commode / defecography chair and a right lateral view of the seated
patient is readied
1. spot image of the patient at rest
2. optional cine and spot images of the patient "lifting" their rectum (Kegel maneuver)
3. optional cine and spot images of the patient straining as if they were about to defecate, but not
actually defecating then, finally, the patient should "go like they would go at home" and spot and
cine images are taken while the patient evacuates their rectum
4. a post-evacuation image with straining should be obtained to look for retained material or
enterocoele

13. RISK FACTORS
• Perforation - Potential abrasion of the rectum during catheter insertion
is a minor risk. Perforation of the rectum during defecography is more a
theoretical than a real risk
• The small amount of radiation exposure from X-ray is considered
safe, as long as it isn’t a regular occurrence. MRI poses no risks or
side effects. If you are pregnant, it's standard practice to avoid
both tests, if possible, even though the risk of harm to the fetus is
very small.

15. MEASUREMENTS
• In evaluating evacuation proctography images, the key reference
line is drawn from the tip of the coccyx to the lower border of
the pubic ramus. Ascent and descent of various structures are
measured in relation to this line.
• Appropriate parameters to be measured during defecography
have evolved over time, based on the contributions of numerous
author

17. THANK YOU