MRI Defecography Report Template

📝 Sample MRI Defecography Report Template

Patient Name:                                                                   Age/Sex:
Referring Physician:

Clinical Indication: Chronic constipation, pelvic organ prolapse, incomplete evacuation, etc.

Technique:

MRI Defecography was performed in the supine position. The rectum was distended with ~120–180 ml of ultrasound gel. Dynamic sequences were obtained at rest, during squeeze, strain, and defecation.

Findings:

1. Rectum:

• At rest: Normal / Redundant / Dilated

• During defecation: Normal emptying / Incomplete evacuation

• Rectocele: Present / Absent – Size (e.g., 2.5 cm)

• Intussusception: Yes / No – Describe level

• Mucosal prolapse: Present / Absent

2. Anal Canal:

• Length: ___ cm

• Sphincter integrity: Intact / Disrupted (internal/external)

• Anismus: Yes / No – (Failure of relaxation noted)

3. Pelvic Floor Descent:

• Pubococcygeal Line (PCL) reference used.

• Perineal descent: Mild / Moderate / Severe (e.g., >3 cm below PCL)

4. Anterior Compartment (Bladder/Urethra):

• Cystocele: Yes / No – Grade (I/II/III)

• Urethral hypermobility: Present / Absent

5. Middle Compartment (Uterus/Vagina):

• Uterine prolapse: Yes / No

• Vaginal vault descent: Yes / No – Degree

6. Posterior Compartment:

• Enterocele: Yes / No – Bowel loop between vagina and rectum

Impression:

• Findings suggest a ___ (e.g., moderate rectocele with internal intussusception and pelvic floor dyssynergia).

• Recommend correlation with clinical symptoms and pelvic floor physiotherapy or surgical consultation.