Thursday, 27 March 2014

A big heart.

Can you spot anything abnormal on this CXR?

Sunday, 16 March 2014

Pelvic floor imaging part 5: what is an enterocoele?

It's been a few weeks but my pelvic floor imaging series is back! So far, the posts have covered whether you need a proctogram, what is involved in having a proctogram, and looking at two of the most common findings on a proctogram test: rectocoele and rectal prolapse. This link will take you to all of my pelvic floor articles. This post focusses on another finding occasionally seen, an enterocoele (or enterocele for North American readers).

An enterocoele (pronounced enter-o-seal) is a prolapse of the small bowel into the pelvis. The bowel is divided into small bowel, which is usually located in the centre of the abdomen, and the large bowel which is located around the edge of the abdomen and ending in the rectum or back passage. The small bowel can sometimes drop down into the pelvis and press on the bladder or rectum, and this is seen particularly after a hysterectomy. In order to see this, all women undergoing a proctogram in my clinic are given a barium drink before the test and this then shows up the small bowel during the test. Without the barium drink, enterocoeles are very difficult to detect. Only women get the drink because enterocoeles are extremely rare in men, due to differences in the pelvic anatomy.

This is an xray image from the end of a proctogram test, showing loops of small bowel containing barium lying directly on top of the rectum:

Saturday, 8 March 2014

International Women's Day: don't forget about women's health

Today, 8th March, is International Women's Day. This is a global celebration of everything that women have contributed to our society, but also highlights important inequalities in women's rights across the world. My particular interest in this day stems from my interest in pelvic floor imaging. 

Pelvic floor problems, and specifically pelvic organ prolapse (POP) and incontinence are major health issues for women, regardless of nationality. However, to a certain extent these are hidden issues. They are hidden away from the media limelight because they are not life threatening like cancer or heart disease. This also means that there is a lack of funding into research, diagnosis and management of these problems. However, any woman who has suffered with pelvic organ prolapse or incontinence will tell you that although not life threatening, it dramatically reduces quality of life, with important and damaging physical, mental and sexual health consequences.

There needs to be a greater emphasis of physician recognition of POP, with an improvement in education starting from medical school. Women need to empowered with information and knowledge on the symptoms of POP. I would like to see more research and collaboration across nations and continents with regards to standardising the investigation (tests) and management of POP. Organisations and websites such as APOPS, Prolapse Matters and Pelvic Guru are doing an amazing job in shifting awareness across the world.

I am doing my bit by blogging about pelvic floor imaging. I hope that the information in my posts can help you to understand the role of radiology and scanning in POP, and reduce the fear of having these tests done.

Dr Vikas Shah
Consultant Radiologist

Monday, 3 March 2014

My pledge for NHS Change Day

Today, 3.3.2014, is the second NHS Change Day. Change Day is about making changes that matter in our everyday practice and reminding ourselves of why we do what we do. Pledges can be big or small; it doesn't matter - the main thing is that each and every person who participates has a belief in the values of the NHS and great patient care, and is passionate about keeping it that way now and in the future. You'll see from the Change Day website that there is a wide range of participants; managers, doctors, nurses, allied health professionals, and patients. 

Today, I am pledging to "undergo the same preparation that my patients do for CT colonography so that I understand how it feels for them". 

So what does this mean?