TOTAL RECTAL PROLAPSE MIMICKING RECTAL TUMOR IN A YOUNG PATIENT: CASE REPORT

Case presentation A 21-year-old male patient, previously healthy, presented with one year of hematochezia, anemia, and a 5 cm rectal prolapse following defecation, requiring manual reduction. He reported a 2 kg weight loss over two months with no changes in bowel habits. The patient denied comorbidities or prior surgeries but recalled an electric shock to the perineal region at age 14. Colonoscopy revealed a friable, stenotic lesion 6 cm from the anal verge (AV), obstructing 80% of the lumen and extending up to 15 cm from the AV. Biopsies showed no malignancy. Endoanal ultrasound demonstrated parietal thickening of the anorectal junction and lower rectum extending to the submucosa, occupying the entire posterior hemicircumference without sphincter involvement. The lesion was located 0.6 cm proximal to the puborectal muscle and 4.4 cm from the anal margin, suggesting rectal prolapse. Dynamic studies identified mucosal prolapse, anismus, and recto-rectal intussusception. Pelvic MRI showed diffuse, expansile thickening, occasionally with a sessile polypoid appearance, throughout the rectum to the anal canal, confined to the muscularis propria, without pelvic lymphadenopathy. Manometry revealed resting pressure 55% below normal, voluntary pressure 50% below normal, preserved sustained contraction, and the presence of anismus. Considering a potential neoplastic process, laparoscopic rectosigmoidectomy with ultralow colorectal anastomosis was planned. Intraoperatively, marked rectal wall thickening and dilation precluded stapling, necessitating a perineal approach. The surgery proceeded without further complications. Histopathology revealed angiodysplasia, hypertrophy of the external muscularis, and fibrosis, with no evidence of malignancy.

Discussion Rectal prolapse is the concentric protrusion of the rectum through the anal canal, often associated with fecal incontinence, constipation, and/or hematochezia. It is most prevalent in elderly women, and its occurrence in young adults is rare, often linked to prior pelvic surgeries, which was not the case here. The treatment of choice is surgical, with abdominal approaches preferred for younger patients and perineal approaches for elderly patients at high surgical risk.

Conclusion Given the uncommon presentation of rectal prolapse in young patients, the possibility of malignant neoplasia cannot be excluded. This consideration may influence the choice of surgical technique.

 

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

Publication History

Article published online:
25 April 2025