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.
