case_images: PMC3270543_01
case_images: T2-weighted saggital view. Patient lying supine with breath held. White line represents "modified pubococcygeal" line. The pelvic floor has been replaced by Permacol following cylindrical abdominoperineal excision.
case_images: CRIM2012-752357.001.jpg
case_images: PMC3270543_01_CRIM2012-752357.001.jpg
case_images: fig1
case_images: This was performed initially at rest with breath hold (no valsalva), and 5-millimeter T2-weighted sagittal and coronal views were obtained (Figure 1).
case_images: T2-weighted saggital view. Patient in supine position performing a Valsalva. The modified pubococcygeal line is seen. The downward migration of the small bowel (curved arrow) below this line is <1 cm indicating an intact reconstructed pelvic floor.
case_images: CRIM2012-752357.002.jpg
case_images: PMC3270543_01_CRIM2012-752357.002.jpg
case_images: fig2
case_images: It was repeated with valsalva (breath hold and pushing down), and the same images were acquired (Figure 2). In the setting of an intact pelvic floor the most inferior aspect of the descending intra-abdominal contents should lie <1 cm below the modified pubococcygeal line as illustrated in Figure 2.
case_images: T2-weighted saggital view. Patient underwent a conventional abdominoperineal excision with primary closure of the pelvic floor. Images are obtained in a supine position with the patient performing a Valsalva. There is abnormal descent (>1 cm) of the pelvic floor with posteroinferior herniation of the bladder (arrowhead) and small bowel (curved arrow) below the pubococcygeal line.
case_images: CRIM2012-752357.003.jpg
case_images: PMC3270543_01_CRIM2012-752357.003.jpg
case_images: fig3
case_images: A control image was obtained from a straining patient who underwent a conventional abdominoperineal excision without pelvic floor reconstruction who had no clinical evidence of a perineal hernia (Figure 3).