Rectoanal mucosal intussusception and rectocele

Case contributed by Dr Vikas Shah

Presentation

Can feel bulge on posterior vaginal wall, has to digitate to open bowels. ? rectocele

Patient Data

Age: 40 years
Gender: Female

Structural findings: 
Normal appearances of the pelvic viscera.

Dynamic findings: 
Measurements obtained using the PCL system at maximal straining are as follows:
Bladder neck: 6 mm below the level of the line (normal)
Uterine cervix: 20 mm above line (normal)
Anorectal junction: 50 mm below line (mild anorectal junction descent)
Rectocele: 38 mm in depth (moderate anterior rectocele)

At the onset of evacuation, there is appropriate relaxation of the anorectal angle and the gel is successfully expelled. Posterior mucosal thickening and intussusception into the rectum is noted, but there is no external prolapse. There is no enterocele.

In summary:
No structural abnormalities.
Descent of predominantly the posterior compartment during evacuation with formation of a moderate size anterior rectocele.
Rectoanal mucosal intussusception but no external prolapse.

Case Discussion

The study confirms the findings from the clinical evaluation of a rectocele.

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