Fig. 18

Descending perineal syndrome with tricompartimental prolapse. (a, b) Sagittal midline TruFISP images at rest (a) and during evacuation (b). H line (blue line) measures 7.7 cm (a) and 9.8 cm (b) and the M line (green line) measures 2.3 cm (a) and 4.5 cm (b), demonstrating widening and descent of the levator hiatus, even at rest but aggravating during defecation. It is also associated with tricompartimental prolapse, with a severe cystocele and a severe uterine everted prolapse. Note the verticalization of the levator plate (white arrow). Another interesting finding is that the rectal contrast is only partially expelled (b), because the mass effect by both the cystocele and uterine prolapse induces mechanical posterior obstruction (dilated rectum filled with ultrasound gel) causing constipation and incomplete evacuation (*). (c) Axial T2-TSE image at the pubic symphysis plane showing bilateral ureterohydronephosis causes by the cystocele (red arrows)