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Prospective Assessment of Interobserver Agreement for Defecography in Fecal Incontinence

Annette C. Dobben1, Tjeerd G. Wiersma2, Lucas W. M. Janssen3, Rien de Vos4, Maaike P. Terra1, Cor G. Baeten5 and Jaap Stoker1

1 Department of Radiology, G1-228, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
2 Department of Radiology, Rijnstate Hospital, Arnhem 6815 AD, The Netherlands.
3 Department of Colorectal Surgery, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands.
4 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands.
5 Department of Colorectal Surgery, Academic Hospital Maastricht, Maastricht 6229 HX, The Netherlands.



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  		Fig. 1 —Drawings show grading system for enterocele: 0 = no enterocele, 1 = enterocele extends into distal half of vagina, 2 = enterocele reaches to perineum, and 3 = enterocele protrudes out of anal canal. Patients with grade 3 enterocele were excluded from this study. (Reprinted with permission from [16])

 


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  		Fig. 2 —Image obtained from 74-year-old woman shows anterior rectocele (r) with extent (arrowed line) measured at right angles to line extended upward from anal canal (black line). (Reprinted with permission from [26])

 


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  		Fig. 3 —Drawings show grading system for intussusception: 0 = no intussusception; 1 = intrarectal intussusception (minimal infolding of part of rectal wall or circumferential infolding that remains intrarectal); 2 = intraanal intussusception (when leading edge of intussusception is intraanal, into orifice of anal canal); and 3 = extraanal intussusception (protruding out of anal canal). Patients with rectal prolapse (grade 3 intussusception) were excluded from this study. (Reprinted with permission from [16])

 


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  		Fig. 4 —Anismus defined as incomplete evacuation after 30 sec or nonrelaxing musculus puborectalis during evacuation in 72-year-old man. Rectum below main rectal fold should empty in less than 30 sec; retention proximally was not significant. We defined complete obliteration of puborectalis impression (P) as total relaxation of puborectalis muscle during attempted evacuation; incomplete obliteration was defined as paradoxical contraction of or inability to relax puborectalis muscle during attempted evacuation, leading to poor rectal emptying. (Reprinted with permission from [16])

 

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