Rectoanal mucosal intussusception and rectocoele
Difficult defaecation with prolonged and excessive straining required
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The pelvic floor has a normal position at rest. There is satisfactory opening of the anorectal angle at the onset of defaecation. At evacuation progresses, a moderate sized anterior rectocoele develops. Thickening and descent of the mid and low rectal mucosa is seen particularly posteriorly, causing some obstruction to the passage of further barium paste, and causing trapping within the rectocoele.
These findings indicate a grade III rectoanal intussusception (limited to mucosa) with a moderate anterior rectocoele, and explain the patient's symptoms relating to obstructed defaecation.