Norihiro Okamoto

Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse

BackgroundDynamic three-dimensional computed tomography (D-3DCT: high-speed helical scanning during defecation) was used for morphological evaluation of intrapelvic structures in patients with rectal prolapse and rectocele.MethodsTwenty-five patients with rectal prolapse or rectocele diagnosed by conventional defecography (CD) or clinical findings were additionally investigated with D-3DCT. D-3DCT images were acquired using a multislice CT system with a 16-row detector during simulated defecation. Helical scanning was performed with a slice thickness of 1 mm, a helical pitch of 15 s/rotation, and a table movement speed of 35 mm/s. The contrast medium, 100 ml of iopamidol (370 mg/ml), was injected at a rate of 2.5 ml/s to enhance contrast with other structures, and scan start was triggered by using a function for automatically determining the optimal scan timing.ResultsAmong the eight patients with rectocele, additional intrapelvic disorders were diagnosed in five (enterocele, 4; cystocele, 1; and uterine prolapse, 1) with D-3DCT. In the 17 patients with rectal prolapse, concomitant intrapelvic disorders were found in six (intussusception, 3; cystocele, 2; uterine prolapse, 2; rectocele, 1; and vaginal prolapse, 1).ConclusionsD-3DCT can be a useful diagnostic tool for investigation of pelvic pathology in patients with rectocele and rectal prolapse.

Abdominal Cocoon in an Aged Man: Report of a Case

An abdominal cocoon is an extremely rare condition, which has been mainly reported in young adolescent women as a cause of small bowel obstruction. In these patients the small bowel is encased in a fibrous sac called an abdominal cocoon. We herein describe a 74-year-old man who demonstrated an abdominal cocoon without having any history associated with an abdominal cocoon. A laparotomy showed bloody ascites and the entire small bowel was encased in a thin white fibrous membrane like a cocoon. The small intestine entered into a defect of the membrane, thus presenting as an internal hernia with intestinal necrosis. The necrotic intestine and the membrane were removed. A histopathological examination of the membrane showed a few signs of inflammation cells.

Enterocele associated with rectocele revealed by dynamic pelvic CT

Enterocele is often associated with other pelvic floor disorders but it is not always possible to detect by clinical examination. Defecography with peritoneography and/or barium meal intake has recently been developed as a new method to identify enterocele, but this method is an invasive procedure. Multislice computed tomography was performed at rest and during simulated defecation to evaluate an 80-year-old female patient who had a defecation disorder and was diagnosed as having rectocele based on results from defecography and clinical findings. Multiplanar reconstruction images were generated for image evaluation. Using this novel method of dynamic pelvic computed tomography, a third-degree enterocele was clearly demonstrated in this case.