ABSTRACT

This study proposes a new classification of enterocoele based on its functional role as a cause of constipation in patients with ODS (obstructed defecation syndrome). We retrospectively evaluated 597 patients (551 F, 46 M) with symptoms of ODS, who had undergone a cinedefecography between November 2001 and November 2005. We classified enterocoele into three groups based on the presence of a radiological pattern of obstructed defecation and the presence of any other functional or anatomical abnormality. An enterocoele was found in 127 females (23%) and 1 male. We recognised prolapse of the small bowel in 103 females and in one male while in 24 females the sigmoid colon descended into the Pouch of Douglas. We found 38 patients ( 6.9% ) with a functional enterocoele, 38 patients (6.9%) with a non obstructive enterocoele and 27 (4.9%) with an obstructive enterocoele. All the 23 patients with sigmoidocoeles were classified as symptomatic non obstructive. In the group with obstructive enterocoele the finding of a radiological pattern of obstructed defecation was higher (26/27) than in the group without an obstructive enterocoele (23/100) (p < 0.001). In patients with obstructive enterocoele the occurrence of concurrent anatomical and functional abnormalities was lower (p < 0.05) than in patients with other classes of enterocoele. From this study we can infer that obstructive enterocoele impairs rectal evacuation and it can be considered the main cause of obstructed defecation in patients with ODS. This new classification can be useful to determine which cases would be likely to benefit from pelvic surgery.