Full thickness external rectal prolapse

Case contributed by Dr Vikas Shah

Presentation

Symptoms of rectal prolapse. Confirm with imaging as not reproduced in clinic.

Patient Data

Age: 30 years
Gender: Female

MRI proctogram

MRI

Structural findings:
Intrauterine contraceptive device noted. Thickening of the mucosa of the rectum but no suspicious lesion. Normal and symmetric appearances of the levator musculature.

Dynamic findings:
Measurements obtained at maximal straining using the PCL system are as follows:
Bladder neck: 26 mm below line (mild cystocele)
Uterine cervix: 26 mm below line (mild uterine cervix descent)
Anorectal junction: full thickness external rectal prolapse, therefore accurate measurement not possible

Rectocele: none

During evacuation, there is marked global pelvic floor descent with formation of a cystocele, uterine cervix descent and a large full-thickness external rectal prolapse.  There is also an enterocele.

In summary:
No structural abnormality.
Global pelvic floor descent with large full-thickness external rectal prolapse and enterocele.

Case Discussion

External prolapses reported by patients may not be reproduced in clinic as the straining used in clinic does not compare with the forces exerted during evacuation, whether it be at home or during a proctogram study; hence imaging is used to confirm the diagnosis.

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