Fig. 5
Obese female patient aged 50 years old with history of five vaginal deliveries and complaining of incomplete evacuation. Defecography shows: (a): anterior rectocele measures 6 cm (arrow). Evidence of rectal intussusception (arrow). Lax pelvic floor. Anorectal angle (115°). 2D ultrasound shows: b Resting: anorectal angle (119°). c Straining: large rectocele filled with gel and appears on straining measures 4 cm and 2 cm empty. Evidence of rectal intussusception. Anorectal angle (119°). 3D ultrasound shows: at rest: (d): levator area: transverse diameter 4.7 cm. AP diameter 6.5 cm. Hiatal area: 18.3 cm2. Thickness of internal sphincter 3 mm (arrow).Thickness of external sphincter 2.7 mm (arrow head). Thickness of PRS about 3.7 mm (double arrows). During squeezing: (e): levator area: transverse diameter 5 cm. AP diameter 6.6 cm. Hiatal area: 17 cm2. Thickness of internal sphincter 2.7 mm (arrow). Thickness of external sphincter 2.4 mm (arrow head). Thickness of PRS about 3 mm (double arrows). During straining: (f): anterior rectocele invaginating the rectovaginal septum. Wide levator area: transverse diameter 5 cm. AP diameter 6.5 cm. Hiatal area: 21.7 cm2. Thickness of internal sphincter 2.3 mm (arrow) attenuated at Lt side to 1.3 mm. Thinning of external sphincter 1.8 mm (arrow head). Thickness of PRS about 3.7 mm (double arrows)