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Full thickness rectoanal intussusception

Case contributed by Vikas Shah
Diagnosis certain

Presentation

Difficult defecation. Feeling of pressure in back passage.

Patient Data

Age: 65 years
Gender: Female
Fluoroscopy

The pelvic floor lies low at rest. A vaginal ring pessary is present. At commencement of evacuation, the anal canal opens with rapid expulsion of the paste, with circumferential infolding of the full thickness of the upper and mid rectum into the low rectum, but not beyond the anal margin. Despite the presence of the ring pessary, there is a moderate size anterior rectocele which empties towards the end of evacuation. No enterocele.

Case Discussion

These are findings of a grade IV intussusception - the full thickness of the rectum prolapsing down into the anal canal but not beyond the anal verge, and can explain the symptom of feeling pressure in the back passage.

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