Fig. 4
Female patient aged 45 years with history of three vaginal deliveries and complaining of feeling a vaginal lump and chronic constipation. Defecography shows: a anterior rectocele about 4 cm. Anorectal angle (120°). 2D ultrasound: b resting: anorectal angle (118°). c Straining: anterior rectocele about 1.4 cm empty and 2.6 cm filled with gel material and invaginating the rectovaginal septum. Anorectal angle (118°). 3D ultrasound shows: at rest (d): levator area: transverse diameter 3.9 cm. AP diameter 5.7 cm. Hiatal area: 16.8 cm2. Thickness of internal sphincter 2.6 mm (arrow). Thickness of external sphincter 3.7 mm (arrow head). Thickness of PRS about 4 mm (double arrows). During squeezing (e): levator area: transverse diameter 3.9 cm. AP diameter 5.3 cm. Hiatal area: 16.3 cm2. Decreased thickness of internal sphincter 1.4 mm (arrow). Thickness of external sphincter 2.8 mm (arrow head). Thickness of PRS about 3.7 mm (double arrows). During straining (f): anterior rectocele invaginating the rectovaginal septum. Wide levator area: transverse diameter 4.3 cm. AP diameter 6.2 cm. Hiatal area: 20.7 cm2. Attenuation of internal sphincter 1.6 mm (arrow). Attenuation of external sphincter 1.7 mm (arrow head). Attenuation of PRS about 2.7 mm (double arrows)