INCIDENCE AND CLINICAL-SIGNIFICANCE OF SIGMOIDOCELES AS DETERMINED BYA NEW CLASSIFICATION-SYSTEM

PURPOSE: A study was undertaken to assess the incidence and clinical s ignificance of sigmoidocele as a finding during cinedefecography. METH ODS: All patients who underwent cinedefecography between July 1988 and July 1992 were prospectively evaluated. Clinical data were assessed b y a standardized questionnaire. Sigmoidocele was classified based on t he degree of descent of the lowest portion of the sigmoid: 1 degrees = above the pubococcygeal line; 2 degrees = below the pubococcygeal lin e and above the ischiococcygeal line; 3 degrees = below the ischiococc ygeal line. This classification was then correlated with the patient's symptoms and percentage of redundancy relative to rectal length. RESU LTS: Twenty-four sigmoidoceles (5.2 percent) were noted in 463 cinedef ecographic studies; 289 of these patients had constipation. These five males and 19 females were of a mean age of 57 (range, 20-77) years. N ine patients had 1 degrees sigmoidocele, seven had 2 degrees, and eigh t had 3 degrees. Percentage of sigmoid redundancy was 51 percent, 65 p ercent, and 88 percent for 1 degrees, 2 degrees, and 3 degrees, respec tively (P = 0.0001). Impaired rectal emptying was present in 16 patien ts (67 percent). Five of eight patients with 3 degrees sigmoidocele un derwent colonic resection with or without rectopexy. The other three p atients were conservatively managed. One of seven patients with 2 degr ees sigmoidocele underwent colectomy, and the other six were conservat ively managed as were all nine patients with 1 degrees. Posttreatment improvement was noted in 100 percent (6 of 6) of patients operated on but in only 33 percent (6 of 18) of patients conservatively treated. T hus, this proposed classification system yielded excellent correlation among the mean of level of the sigmoidocele, percentage of redundancy , and clinical symptoms. Furthermore, clinical significance of 3 degre es sigmoidocele is supported by the fact that all five of 3 degrees pa tients who underwent colonic resection reported symptomatic improvemen t at a mean follow-up of 23 (range, 15-39) months. CONCLUSION: Sigmoid ocele may account for symptoms of obstructed defecation, and, therefor e, it must be considered in the differential diagnosis and evaluation of constipation. Staging of sigmoidocele is useful in determining both clinical significance and optimal treatment.