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Defäkationsobstruktion

Obstructed defecation

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Zusammenfassung

Die adäquate Behandlung der Defäkationsobstruktion (Outlet-Obstruktion bzw. Stuhlentleerungsstörung) ist wegen der vielfältigen Ursachen und klinischen Ausprägungsformen nicht selten eine Herausforderung. Die Funktionsdiagnostik hat zum Ziel, die Defäkationsobstruktion von der Slow-transit-Obstipation zu unterscheiden, darüber hinaus morphologische Veränderungen von Kolon, Rektum und Beckenboden von funktionellen Störungen zu differenzieren. Mit der bildgebenden Diagnostik (Defäkographie, dynamisches Beckenboden-MRT) ist es möglich, häufige segmentäre Transportstörungen (Sigmoidozele, Cul-de-sac-Syndrom) nachzuweisen, bei denen chirurgische Therapieoptionen ebenso wie beim manifesten Rektumprolaps mit guten funktionellen Ergebnissen durchgeführt werden können. Die Diagnostik und Therapie der symptomatischen Rektozele und des inneren Rektumprolaps (Intussuszeption) hingegen ist kontrovers. Funktionelle Störungen sind eine Domäne der konservativen Therapie (Biofeedback). Entscheidend bleibt, durch eine standardisierte Funktionsdiagnostik die Patienten zu selektionieren, die von einer operativen Therapie profitieren.

Abstract

Adequate therapy of obstructed defecation (pelvic outlet obstruction) is often challenging, as the etiology and clinical symptoms include a wide range of disorders. Standardized diagnostic assessment has to differentiate between obstructed defecation caused by either pelvic outlet obstruction or slow transit constipation. Additionally, morphologic changes of colon, rectum, or the pelvic floor have to be separated from functional disorders. Providing defecography or dynamic MR of the pelvic floor, common causes of outlet obstruction such as sigmoidoceles, in which surgery is indicated, and rectal prolapse can be diagnosed with high accuracy. However, the diagnosis and therapeutic options in symptomatic rectocele and intus-susception are controversial. Patients with functional disorders such as rectoanal dyssynergia are candidates for conservative treatment (biofeedback). To identify patients who will benefit from surgery for obstructed defecation, careful patient selection remains the crucial issue in diagnostic assessment.

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Authors and Affiliations

  1. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    H.-P. Bruch, F. Fischer, T. H. K. Schiedeck & O. Schwandner

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck

    H.-P. Bruch

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  1. H.-P. Bruch
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  2. F. Fischer
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  3. T. H. K. Schiedeck
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  4. O. Schwandner
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Correspondence to H.-P. Bruch.

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Bruch, HP., Fischer, F., Schiedeck, T.H.K. et al. Defäkationsobstruktion. Chirurg 75, 861–870 (2004). https://doi.org/10.1007/s00104-004-0921-x

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  • DOI: https://doi.org/10.1007/s00104-004-0921-x

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