Rectoanal intussusception

Last revised by Arlene Campos on 7 May 2024

Rectoanal intussusception refers to the telescoping or infolding of the rectal wall within the rectum itself, or into the anal canal, or externally, during defecation.

Rectoanal intussusception is also termed internal intussusception and internal procidentia1 .

Rectoanal intussusception is present in 12-31% of patients with obstructed defecation syndrome 2 .

The gold standard for diagnosis of rectoanal intussusception is fluoroscopic evacuation proctography. When compared with MRI defecating proctography, intussusception was observed at a higher frequency in fluoroscopic tests, partly related to the higher rate of rectal emptying on fluoroscopic studies versus MRI 23,24.

It is possible to diagnose rectoanal intussusception on digital rectal examination or with proctoscopy but it is not very helpful in case of short intussusceptions 6.

Rectoanal intussusception may be symptomatic or asymptomatic.
The presenting symptoms are:

  • obstructed defecation

  • fecal incontinence and leakage

  • solitary rectal ulcer

  • rectal bleeding

  • pain

The underlying etiology and pathophysiologic processes are not yet clear. In some instances, the intussusception is considered to be the primary abnormality, part of global pelvic floor failure, and associated with symptoms of obstructed defecation syndrome or fecal incontinence. In other cases, chronic straining due to other disorders such as constipation or a rectocele may lead to incidental mucosal intussusception.

The literature is varied in recommendations on how intussusception should be described. Conventionally, they are described in terms of the location they reach (rectal, anal or external) and whether they are mucosal or full thickness 22. The consensus statement from a North American group suggested using the terms intrarectal, intra-anal or external 21.

  • telescoping of mucosa or full thickness of rectum into the low rectum, anal canal or beyond the anal verge during defecation

  • associated findings may include rectocele, sigmoidocele and enterocele

  • similar findings to fluoroscopic proctography

  • medical therapy 15

  • biofeedback therapy 16

  • mucosal proctectomy (transanal Delorme's procedure) 17

  • abdominal rectopexy18

  • stapled transanal rectal resection (STARR) 19

Allingham first described this condition in 1873 20 .

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