EC Gastroenterology and Digestive System

Aim: To highlight the potential for a new and unexpected role of MR defecography in FBD.

Materials and Methods: The imaging series and clinical findings of 84 consecutive patients [67 (79.7%) women aged 56 ± 8.5 yr, range 18 - 83 yr and 17 (20.2%) men aged 55 ± 3.2 yr, range 30 - 78 yr] referred to our Diagnostic unit for MR defecography during the last 32 months were reviewed with regard to: a) specialization of the referring physician; b) clue for exam and presenting symptoms and; c) diagnostic yield.

Results: The request from the gastroenterologist ranked first with 62 cases (73.8%) followed by that of coloproctologist in 12 (14.2%). The most frequent reason for referral occurring in 47/84 (55.9%) has been a combination of symptoms consistent with FC (abdominal bloating and distention, stool frequency < 3/week with or without strain at stool and need to provoke evacuation by laxatives). In up to 13/84 (15.4%) this was followed by recurrent episodes of left lower quadrant pain, fecal urgency and change in bowel habit with or without symptom’s release after evacuation, as it occurs in irritable bowel syndrome (IBS). Interestingly, the chronic use of antidepressants ranked third in 12/84 cases (14.2%) and was associated with episodes of diarrhea, staining and minor incontinence more frequently than with difficulty at stools (8 vs 4). At imaging, besides presence of well known changes such as rectocele, intussusception and ano-rectal dyssynergia alone or in combination (41%), typical features in FC included rectal inertia (28%) and abnormally enlarged colonic segments with fecal impaction, namely in the cecum and transverse colon and rectum, in the absence of any sensation of fullness or need to evacuate (48%). On the other hand, typical MR feature seen in IBS has been the “concertina-shaped” sigmoid colon, allowing clear differentiation in 35% of cases with that of diverticular disease which was responsible of similar presenting symptoms.

Conclusion: New horizons in image analysis and interpretation of MR defecography can be anticipated under the increasing influence of gatroenterolosist’s referrals for FBD such as IBS, FC and evacuation disorders other than ODS.  

 Keywords Functional Bowel Disorders; Chronic Constipation; Irritable Bowel Syndrome; Functional Constipation; MR-Defecography; Epidemiology of FBD

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