MULTIDISCIPLINARY APPROACH TO TOTAL RECTAL AND UTERINE PROLAPSE IN A REGIONAL HOSPITAL OF THE FEDERAL DISTRICT – CASE REPORT

Case Presentation A 74-year-old patient, G2PN1C1, denied any comorbidities, allergies, alcohol use, or smoking. She complained of uterine prolapse that started 10 years ago and rectal prolapse that began 9 years ago. She reported recurrent episodes of urinary and fecal incontinence, as well as secretions due to the prolapsed organs. On physical examination, she presented with total uterine prolapse and total rectal prolapse measuring approximately 30 cm from the anal margin. She was admitted electively to a public regional hospital in the Federal District for simultaneous management by the Gynecology and Proctology teams. The surgery was performed in three stages. In the first stage, by the Gynecology team, a vaginal hysterectomy and vaginectomy were performed. The second stage, by the Proctology team, consisted of an Altemeier procedure (perineal rectosigmoidectomy), and the third stage, again by the Gynecology team, included posterior colpoperineoplasty and transobturator sling placement. The procedure occurred without complications. The patient had a good clinical and laboratory evolution in the following days, tolerated diet well, and had normal evacuations on the second postoperative day. She was discharged for outpatient follow-up.

Discussion Rectal prolapse has an unclear pathophysiology, with several associated factors, and can occur at any age. 85% of patients with prolapse are women, with a much higher incidence after the age of 60, with no difference between multiparous and nulliparous women. Uterine prolapse is part of a condition called pelvic organ prolapse. Symptoms can occur at any age but are more significant in older women, affecting up to 50% of women during this stage of life, with a peak between ages 70 and 79. The association of rectal and uterine prolapse occurs more frequently in older women and is found in a variable frequency of 16% to 27%. Both conditions share coincident etiological factors: age over 60 years, multiparity, increased intra-abdominal pressure (chronic obstructive pulmonary disease, constipation), genetic diseases that affect collagen or elastin (Ehlers-Danlos syndrome, joint hypermobility, Marfan syndrome), obesity, among others.

Conclusion This clinical case describes a rare association between two conditions that compromise functionality and quality of life in affected patients. Surgical treatment and multidisciplinary care follow-up provided an advantage in the resolution of the case.

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Artikel online veröffentlicht:
25. April 2025