RECTAL PROLAPSE IN A FEMALE PATIENT: CASE REPORT

Case Presentation A 70-year-old female patient with a history of diabetes, hypertension, dyslipidemia, and four vaginal deliveries presented with active rectal bleeding, urinary urgency, lower abdominal pain, and fecal and urinary incontinence during minor physical efforts for three years. Previous medical consultations did not resolve her symptoms. On physical examination, rectal prolapse of approximately 14 cm from the anal canal was observed. Defecography MRI revealed diffuse thinning of the pelvic floor muscles, an open internal anal sphincter, and an open, shortened anal canal at rest. Additionally, moderate uterine prolapse, severe perineal descent with pronounced peritoneocele and sigmoidocele, a 14 cm descent of the anorectal junction below the pubococcygeal line, and significant rectal prolapse were noted. Anorectal manometry showed resting and contraction pressures below normal limits, with reduced short and ultrashort waves in the manometric trace and decreased rectal sensitivity. As part of the diagnostic workup, the patient was referred for both hysterectomy and rectopexy surgery.

Discussion Rectal prolapse is a relatively rare and benign condition, with a prevalence of approximately 0.5% in the general population. It manifests as rectal protrusion through the anus and is more common in women of the patient's age group. Typical symptoms include rectal bleeding, fecal incontinence, and lower abdominal pain. The presence of rectal prolapse during physical examination aids in confirming the clinical diagnosis, supported by defecography MRI findings. In this case, surgical intervention is well-indicated. Various surgical techniques, such as Delorme's procedure, abdominal rectosigmoidectomy, or anal rectosigmoidectomy, may be evaluated to eliminate prolapse, correct functional abnormalities related to incontinence and constipation, and prevent intestinal complications. Consequently, the initial referral for gynecological surgery is reasonable, emphasizing the necessity of a holistic evaluation and consideration of the patient's comorbidities in treatment planning.

Conclusion This case underscores the importance of a comprehensive and individualized approach to managing rectal prolapse. It highlights the need to address the condition itself alongside any comorbidities and additional factors that may influence disease progression and therapeutic outcomes.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025