The existence and clinical implications of sig-moidocele are controversial. We have demonstrated that a deep rectovaginal pouch may contain small bowel at one time and sigmoid at another time, in the same patient. Jorge et al19 maintain that, as opposed to the small bowel, the herniated sigmoid is more prone to stasis, owing to its larger diameter and more solid contents.
Jorge et al19 undertook a study to assess the incidence and clinical significance of sigmoi-
doceles as a finding during cindefecography. Twenty-four (5.2%) sigmoidoceles were noted during 463 cinedefecographic studies. Sigmoidoceles were classified based on the degree of descent of the lowest portion of the sigmoid loop during maximum straining in relation to the following anatomic landmarks: pubis, coccyx, and ischium. First-degree sigmoidocele was considered when the intrapelvic loop of sigmoid was observed on the cinedefecography but the sigmoid did not pass caudad to the pubococcygeal line; second-degree sigmoidoceles included sigmoid loops below the pubococcygeal line but above the ischeococcygeal line; third-degree sigmoidoceles consisting of loops of bowel transcending caudad to the ischiococ-cygeal line. Constipation symptoms were present in 20 of the 24 (83%) patients. The most common sensations were incomplete evacuation, straining, pelvic bloating, rectal pressure or fullness, infrequent bowel movements, and abdominal pain. Two thirds of these patients required assisted defecation including laxatives, enemas, and suppositories. Nine patients had first-degree, seven had second-degree, and eight had third-degree sigmoidoceles. The proposed classification system yielded excellent correlation among the mean level of the sigmoidocele, the degree of the sigmoid redundancy, and clinical symptoms. The clinical significance of third-degree sigmoidoceles were supported by the fact that all eight patients in that group were women with severe evacuatory difficulties, seven of whom had impaired rectal emptying on cinedefecography. All five patients with third-degree sigmoidoceles who underwent sigmoid resection reported significant symptomatic improvement at a mean follow-up ranging from 14 to 16 months.
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