Rectal Prolapse
24 results
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Pelvic Floor- A 45-year-old patient, gravida 4, para 4, who has no comorbidities presents with full-thickness rectal prolapse. She has not undergone prior anorectal surgery and has had a normal colonoscopy. She reports regular bowel movements without straining and no history of chronic constipation. What is the best next approach in her management?
- An 89-year old with multiple comorbidities presents with recurrent rectal prolapse after prior sigmoid resection and rectopexy for rectal prolapse and chronic constipation. Which of the following carries the highest risk for bowel ischemia?
- A 75-year-old patient presents with recurrent full-thickness 6-cm rectal prolapse after an Altemeier procedure. She reports rectal bleeding and fecal incontinence and she asks for a repeat operative intervention. What is the best next operative approach?
- A 67-year-old female patient presents with full-thickness rectal prolapse. Other than this condition, she is healthy. Dynamic pelvic magnetic resonance imaging (MRI) shows a 4-cm rectocele with incomplete evacuation of contrast and the known full-thickness rectal prolapse. What is the best surgical option for her?
- A 75-year-old female patient with fecal incontinence presents for stage 1 sacral neuromodulation. Upon lead stimulation, which of the following findings would be associated with optimal lead position?
- An otherwise healthy 63-year-old woman has a reducible 6-cm rectal prolapse. She is very symptomatic and requests surgical intervention. Which of the following operative steps is most likely to increase the risk of de novo constipation during an abdominal operation for prolapse?
- An 84-year-old woman presents to your office with bloody mucoid drainage from the rectum. She had a normal colonoscopy 1 year ago. On examination, you find a 2-cm circumferential partial-thickness rectal mucosal prolapse; the anterior and middle compartments appear normal. Which of the following is the most appropriate surgical management?
- A 75-year-old female patient with advanced dementia has rectal prolapse requiring manual reduction for the past 3 years. She was brought to the emergency department from the nursing home because the rectal prolapse had become completely irreducible for the previous 2 days. Clinical examination shows a massive nonreducible rectal prolapse with evidence of mucosal necrosis. What is the best next step in management?
- An 83-year-old female patient presents to the emergency department with increased perineal pressure, bleeding, and discomfort. See the figure for a photo of the patient’s perineum. An initial attempt to reduce it was unsuccessful. What is the next best initial treatment?
- A 65-year-old woman presents with a 4-month history of progressively worsening fecal incontinence. The patient initially noted the intermittent uncontrolled passage of gas and liquid stools. However, she now reports daily uncontrolled passage of solid stools. She notes that this has been debilitating, preventing her from interacting with friends and family during her usual activities. The patient reports three vaginal births, with a grade 3 perineal tear occurring during her last delivery requiring repair. The best modality to evaluate her fecal incontinence is
- An 89-year-old woman with end-stage Parkinson’s disease is admitted to the hospital with fecal impaction. Computed tomography demonstrates a transition point at the anus. The patient’s caretaker reports she had an operation last month for rectal prolapse. Which of the following techniques is most likely to have contributed to her current presentation?
- A 54-year-old healthy woman, gravida 3, para 3, with morbid obesity is seen in the clinic for a recurrent rectal prolapse 1 year after posterior suture rectopexy. She reports a bulge in the vagina for many years that has not changed with the rectopexy. Colonoscopy shows a redundant sigmoid colon. Which of the following most likely contributed to the recurrence of rectal prolapse?
- A 73-year-old woman presents with increasing difficulty with defecation that requires significant straining, minimal passage of stools, and a sensation of incomplete evacuation. Trials of lifestyle change, laxatives, and biofeedback therapy have all been successful in improving symptoms. Under normal circumstances during defecation (i.e., normal physiologic conditions), the anorectal angle
- A patient presents with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. Endoscopy demonstrates two small ulcers in the mid-rectum with microscopic findings of fibromuscular obliteration of the lamina propria and hypertrophy and disorganization of the muscularis mucosa. Rectal prolapse is not seen on physical examination. The best next step in the management of this patient is
- A 72-year-old woman presents to your clinic with complaints of straining at defecation, feeling incomplete evacuation, and is very distressed about it. She has taking laxatives for constipation, without benefit. She feels pelvic pressure as well. Her gastroenterologist has already ruled out total colonic inertia by Sitz marker test and has done a colonoscopy with no significant findings. What is the best next step?
- A 54-year-old female reports increased fecal incontinence. Her surgical history is significant for total abdominal hysterectomy. Physical examination suggests small partial thickness rectal prolapse. Magnetic resonance imaging (MRI) defecography suggests grade III intussusception and is also suggestive, but inconclusive, for the presence of enterocele. What is the best next step in evaluation for enterocele?
- Anorectal Disease
- A 38-year-old patient presents with symptomatic grade 3 internal hemorrhoids. Which of the following is a contraindication to stapled hemorrhoidopexy?
- A 46-year-old man presents to your office with rectal bleeding associated with bowel movements and prolapse of tissue from his anus that spontaneously reduces. Recent colonoscopy demonstrated moderate internal hemorrhoids and a 3-mm tubular adenoma in the sigmoid colon removed with cold forceps. A single rubber band ligation was performed during this procedure. Two days later, he presents to the emergency department with a fever of 102°C, pelvic pain, and urinary retention. The most definitive treatment is
- Patient presents with bleeding per rectum with bowel movements and partial hemorrhoidal prolapse with straining and spontaneous reduction. Patient had a colonoscopy 12 months ago that only showed enlarged hemorrhoids. Patient has been on supplemental fiber for the past 6 months. The best next treatment for this patient’s rectal bleeding is
- Benign Disease
- A 36-year-old patient with ulcerative colitis (UC) underwent total proctocolectomy with ileal pouch anal anastomosis (IPAA) 3 years ago. The patient presents now with lower abdominal discomfort that is associated with bloody loose stools. Endoscopy shows erythematous friable rectal cuff with deep ulcers. The rest of the pouch appears normal. What is the most appropriate treatment?
- An endoscopic evaluation of an ileoanal pouch for investigation of increased frequency of bowel movements and intermittent rectal bleeding finds well-demarcated mucosal ulcers with white, depressed centers and a halo of erythema on the afferent limb of the J-pouch. Biopsies are most likely to show
- Five years after abdominoperineal resection (APR) for rectal cancer, a 57-year-old woman presents with bulging at the site of a left lower quadrant colostomy. She is concerned regarding her physical appearance and symptoms of rare fecal leakage at the appliance. The best initial treatment for this patient is
- Malignancy
- Colon and Rectal Surgery Educational Program (CARSEP)