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3 Table 1. Summary of PatientsData Pt Sex ge Symptoms CTT Defecography Colonoscopy Manometry a-enema 01 F 38 constipation POO rectocele hemorrhoid negative 02 F 75 constipation normal PDS, rectal intu normal positive 03 F 78 defecation difficulty colonic inertia rectocele, PDS positive normal 04 F 58 constipation normal rectocele, PDS normal positive normal 05 M 70 defecation difficulty POO SPFS colon polyp negative 06 F 37 constipation normal rectocele, SPFS normal positive 07 F 52 constipation normal rectocele hemorrhoid negative 08 F 49 constipation normal rectocele colon polyp negative 09 F 72 constipation normal PDS, rectal intu negative normal 10 M 71 constipation normal normal hemorrhoid positive 11 M 62 constipation normal normal colon polyp positive normal 12 F 82 constipation POO rectocele hemorrhoid negative 13 M 75 constipation POO normal normal negative 14 F 68 constipation normal SPFS negative 15 F 60 defecation difficulty normal rectal intu hemorrhoid negative 16 F 47 constipation POO, colonic inertia normal colon polyp negative colon polyp 17 F 42 constipation normal rectocele hemorrhoid positive normal 18 F 57 constipation POO, colonic inertia rectocele, PDS normal negative 19 F 38 constipation POO, hindgut dysfunction normal normal negative 20 F 54 constipation POO rectocele hemorrhoid positive normal 21 M 63 constipation POO PDS, rectal intu colon polyp negative 22 F 49 constipation normal rectocele, PDS normal positive 23 F 55 constipation normal rectocele negative 24 F 62 constipation POO rectocele colon polyp negative 25 F 59 constipation colonic inertia SPFS colon polyp positive 26 F 63 constipation POO normal hemorrhoid negative normal CTT: colon transit time POO: pelvic outlet obstruction PDS: perineal descent syndrome intu: intussusception SPFS: spastic pelvic floor syndrome positive / negative in manometry: abnormally increased / normal anal sphincter tone 411

박경석 외: 만성 변비 환자에서 대장통과시간 검사와 배변조영술의 유용성 인 경우가 1명이었다.

따라서 대장통과 시간이 지연된 환자는 대장절제술, 비정상적 골반기능을 가진 환자는 바이오피드백 같은 골반기능 훈련을 통해 치료효과를 기대해 볼 수 있는 것과 같이 대장의 운동기능 저하와 골반출 구 폐쇄는 치료 방법이 다르므로 정확한 진단이 요구된다.

1. 75-year-old woman with rectal intussusception and mild degree of perineal descent syndrome on defecography, and normal transit time on colonic transit time (CTT).

. On defecography, mild degree of downward displacement of anorectal junction and rectal intussusception (arrows) are visualized.

4 박경석 외: 만성 변비 환자에서 대장통과시간 검사와 배변조영술의 유용성 인 경우가 1명이었다. Nyam 등(7)은 심한 변비 환자의 60%가 정상 대장통과시 간과 정상 골반기능을 가지고 있었고 이들에서는 과민성 대장 증후군이 중요 원인이라고 하였으므로, 대장통과시간이 정상 인 사람도 변비를 호소할 수 있다고 하겠다. 따라서 대장통과 시간이 지연된 환자는 대장절제술, 비정상적 골반기능을 가진 환자는 바이오피드백 같은 골반기능 훈련을 통해 치료효과를 기대해 볼 수 있는 것과 같이 대장의 운동기능 저하와 골반출 구 폐쇄는 치료 방법이 다르므로 정확한 진단이 요구된다. 골반출구 폐쇄는 청각 또는 시각 피드백(feedback)을 이용 하여 항문괄약근과 치골직장근의 기능을 훈련시키는 바이오피 드백으로 좋은 치료 효과를 볼 수 있고 외래에서 통원 치료가 가능하며 합병증이 없다고 주장되고 있으나, 변비에 대한 각 종 진단 방법의 진단 기준이 아직은 모호하여 정확한 진단이 Fig year-old woman with rectal intussusception and mild degree of perineal descent syndrome on defecography, and normal transit time on colonic transit time (CTT).. On fourth day film of CTT, only 4 radiopaque rings are noted in the rectosigmoid colon, suggesting normal transit time.. On defecography, mild degree of downward displacement of anorectal junction and rectal intussusception (arrows) are visualized. Note the unusually wide anorectal angle during resting phase. Fig year-old woman with perineal descent syndrome and small rectocele on defecography, and normal transit time on CTT.. On fourth day film of CTT, 6 radiopaque rings in the pelvic cavity and 1 ring in the left colon are demonstrated, suggesting normal transit time.. On defecography, severe degree of downward displacement of the anorectal junction and small size of anterior rectocele (arrow) are noted. 412

. On fourth and seventh day films of CTT, many radiopaque rings are remaining in the rectosigmoid colon area

68-year-old woman with pelvic outlet obstruction on CTT and spastic pelvic floor syndrome on defecography.

5 대한영상의학회지 2006;54: Fig year-old woman with pelvic outlet obstruction on CTT and large rectocele on defecography.. On fourth and seventh day films of CTT, many radiopaque rings are remaining in the rectosigmoid colon area without interval change, suggesting pelvic outlet obstruction.. On defecography, about 4 cm size anterior rectocele is noted during straining phase. Fig year-old woman with pelvic outlet obstruction on CTT and spastic pelvic floor syndrome on defecography.. On fourth and seventh day films of CTT, many radiopaque rings are remaining in the rectosigmoid colon area without interval change, suggesting pelvic outlet obstruction.. On defecography, the contour of anorectum is grossly normal with normal anorectal angle during resting phase. However, anorectal angle (*) is abnormally decreased during defecation phase, suggesting spastic pelvic floor. 413

6 1. Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. m J Gastroenterol 1998;93: Haubrich WS, Schaffner F, erk JE. ockus Gastroenterology 5th ed. Philadelphia: Saunders. 1994: Wald. Colonic transit and anorectal manometry in chronic idiopathic constipation. rch Intern Med 1986;146: Mezwa DG, Feczko PJ, osanko C. Radiologic evaluation of constipation and anorectal disorders. Radio Clin North m 1993;31: Hiltunen KM, Kolehmainen H, Matikainen M. Does defecography help in diagnosis and clinical decision-making in defecation disorder? bdom Imaging 1994;19: Karasick S, Ehrlich SM. Is constipation a disorder of defecation or impaired motility?: distinction based on defecography and colonic transit studies. JR m J Roentgenol 1996;166: Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum 1997;40: Lester, Pennick F, Kerremans R. iofeedback defecation training for anismus. Int J Colorect Dis 1991;6: Turnbull GK, Ritvo PG. nal sphincter biofeedback relaxation treatment for woman with intractable constipation syndromes. Dis Colon Rectum 1992;35: Jorge JM, Wexner SD, Ger GC, Salanga VD, Nogueras JJ, Jagelman DG. Cinedefecography and electromyography in the diagnosis of nonrelaxing puborectalis syndrome. Dis Colon Rectum 1993;36: Ger GC, Wexner SD, Jorge JM, Salanga VD. norectal manometry in the diagnosis of paradoxical puborectalis syndrome. Dis Colon Rectum 1993;36: ,,,,, ;38: Wald. pproach to the patient with constipation. In Yamada T, lpers DH. Textbook of gastroenterology. Philadelphia: Lippincott. 1991: Chaussade S, Khyari, Roche H, Garret M, Gaudric M, Couturier D, et al. Determination of total and segmental colon transit time in constipated patients: results in 91 patients with a new simplified method. Dig Dis Sci 1989;34: Turnbull GK, artram CI, Lennard-Jones JE. Radiologic studies of rectal evacuation in adults with idiopathic constipation. Dis Colon Rectum 1988;31:

7 Usefulness of Colon Transit Time and Defecography in Patients with Chronic Constipation 1 Kyoung Seuk Park, M.D., Jae-Joon Chung, M.D. 1, 2, Myung Hyun Kim, M.D., Sumi Park, M.D., Hee Chul Yang, M.D. 1 Department of Diagnostic Radiology, NHIC Ilsan Hospital 2 Department of Diagnostic Radiology, YongDong Severance Hospital, YUMC Purpose: We wanted to evaluate whether both the colonic transit time (CTT) and defecography are necessary for diagnosing constipated patients, and we also wanted to assess the defecographic findings of patients with outlet obstruction on CTT. Materials and Methods: Over the recent 3 years, 26 patients (21 women and 5 men, mean age: 59 years) underwent both CTT and defecography because of their chronic constipation or defecation difficulty. The mean interval between the 2 studies was 48 days. Colonoscopy, barium enema and manometry were performed in 22, 8 and all the patients, respectively. Results: On CTT, 13 patients (50.0%) were normal and 13 patients (50.0%) were abnormal; the abnormal results were composed of outlet obstruction (n=8, 30.8%), outlet obstruction and colon inertia (n=2, 7.7%), colon inertia (n=2, 7.7%), and outlet obstruction and hindgut dysfunction (n=1, 3.8%). On defecography, 6 patients (23.1%) were normal and 20 patients (76.9%) were abnormal; the results were composed of rectocele (n=8, 30.7%), rectocele and perineal descent syndrome (PDS; n=4, 15.4%), PDS and rectal intussusception (n=3, 11.5%), spastic pelvic floor syndrome (SPFS; n=3, 11.5%), rectocele and SPFS (n=1, 3.8%), and rectal intussusception (n=1, 3.8%). Of the 11 patients with outlet obstruction on CTT, rectocele (n=4, 36.4%), SPFS (n=1, 9.1%), rectocele and PDS (n=1, 9.1%), and PDS and rectal intussusception (n=1, 9.1%) were demonstrated on defecography, except for the 4 normal cases. Conclusion: oth CTT and defecography were necessary for diagnosing the patients with chronic constipation in compensation, and 63.6% of the patients with pelvic outlet obstruction showed an abnormal pelvic defecation function. Index words : Colon Defecography Colonoscopy ddress reprint requests to : Jae-Joon Chung, M.D., Department of Diagnostic Radiology, YongDong Severance Hospital, YUMC , Dogok-dong, Gangnam-gu, Seoul , Korea. Tel Fax jjchung@yumc.yonsei.ac.kr 415

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical