Question

On defecography, a rectocele is considered significant when the anterior bulging of the rectal wall into the posterior vaginal wall exceeds:

• A. 1 cm
• B. 2 cm
• C. 5 cm
• D. 7 cm

Hint:

Small is under this; significant rectocele begins at this depth.

Answer 1

The Correct Option is B

Step 1: Define a rectocele. A rectocele is herniation of the anterior rectal wall into the posterior vaginal wall, typically from weakening of the rectovaginal septum. It is assessed on defecography (evacuation proctography) by measuring the depth of anterior bulging beyond the expected line of the anterior rectal wall.

Step 2: Apply the depth grading. Defecography grades rectoceles by depth: small < 2 cm, moderate 2-4 cm, large > 4 cm. A rectocele is regarded as clinically significant when its depth is > 2 cm (commonly stated as &ge; 2-3 cm), as this size correlates with obstructed defecation, stool trapping and the need for vaginal/perineal splinting.

Step 3: Evaluate the options. 1 cm is within the normal/insignificant range. 5 cm and 7 cm are large rectoceles but represent thresholds far above the cut-off, not the defining limit for &ldquo;significant.&rdquo; The accepted significance threshold is 2 cm.

Step 4: Conclude. Anterior bulging exceeding 2 cm marks a significant rectocele on defecography.

Key fact: A rectocele is significant when the bulge depth is > 2 cm on defecography.