Rectal Prolapse
20 results
1 - 20
Pelvic Floor- A 59-year-old woman presents with full-thickness rectal prolapse 6 years after sigmoid resection and rectopexy. She complains of significant discomfort and fecal urgency. Dynamic magnetic resonance imaging defecography demonstrates full-thickness rectal prolapse without anterior or middle compartment involvement. Which of the following procedures is contraindicated in the management of this patient’s rectal prolapse?
- A 37-year-old woman presents with a large rectocele and no other evidence of pelvic organ prolapse. Compared to transanal repair of the rectocele, transvaginal repair has a higher rate of:
- An 80-year-old woman with multiple comorbidities has hemorrhoids and fecal incontinence. On examination, you observe full-thickness rectal prolapse and offer a perineal proctectomy. What additional procedure may improve continence?
- A 67-year-old woman undergoes defecography for chronic constipation. Which of the following images represent an abnormal finding on defecography?
- A 73-year-old woman presents with a history of constipation, fecal soiling, and a mass protruding from her rectum. Examination reveals a complete rectal prolapse, and the patient undergoes a transabdominal surgical repair. Six months later, she returns with severe constipation. Which surgical maneuver may have contributed to this patient’s recurrent constipation?
- An 80-year-old woman with multiple comorbidities presents with chronic, full-thickness rectal prolapse. The patient recognizes the need for surgery and inquires about the durability of surgical repair. Which repair option is associated with the highest rate of recurrent rectal prolapse?
- A 75-year-old woman with chronic rectal prolapse wishes to discuss surgical treatment planning. She has prolapsing tissue with defecation, which is lifestyle limiting due to bleeding, fecal smearing, and pain. On physical examination, she has a 1.5-cm segment of circumferential prolapsing rectal mucosa with a focal anterior ulcer, no rectocele, and moderate baseline tone. She is frail, with a medical history significant for coronary artery disease after stent placement, receives dual antiplatelet therapy, and has a caretaker to assist with daily activities. What is the best surgical approach for repair of this patient’s prolapse?
- A 37-year-old man with developmental delay and lifelong intermittent rectal prolapse presents to the emergency department with the findings shown in the Figure. Attempts at reduction of the prolapse are unsuccessful, and while waiting for the operating room, the mucosa develops patchy necrosis. What is the best next step in management?
- An 87-year-old woman, American Society of Anesthesiology class IV, presents with an incarcerated rectal prolapse. Attempt at manual reduction is unsuccessful. What is the best next step in management?
- A 64-year-old woman presents to the clinic with a 5-month history of rectal prolapse and urinary leakage. On examination, you confirm a 5-cm full-thickness rectal prolapse. A colonoscopy 2 years ago revealed sigmoid diverticulosis. What is the best next step in management?
- A 25-year-old woman presents with rectal bleeding, tenesmus, and constipation. She reports daily severe straining with bowel movements for many years. A flexible sigmoidoscopy in performed, which demonstrates erythematous mucosa with polypoid changes and ulcerations 4 cm proximal to the dentate line. The changes are limited to the anterior rectal wall. What will a biopsy most likely demonstrate?
- A 40-year-old-woman presents to the clinic with a history of rectal bleeding, difficult defecation, and mucus discharge. Colonoscopy reveals thickening of the anterior rectal wall and multiple shallow ulcers. Rectal ulcer biopsy reveals fibrous obliteration of the lamina propria and no malignancy. What is the most appropriate next step?
- A 58-year-old woman presents with a rectovaginal fistula of 10 years’ duration. She has increased fecal urgency and incontinence of gas and stool. She had 2 vaginal deliveries with forceps and episiotomy repair, and was recently diagnosed as having diabetes. Which diagnostic study is most helpful in evaluating the cause of her incontinence?
- Anorectal Disease
- A 47-year-old man with chronic constipation presents with increasingly painful prolapsed perianal tissue of 3 days’ duration (Figure) Which of the following is the best next step in treatment?
- A 68-year-old man with end-stage liver disease presents with repeated episodes of lower gastrointestinal bleeding resulting in symptomatic anemia with hypotension. Colonoscopy shows prominent veins in the submucosa of the lower rectum. Which of the following is the most durable treatment option?
- A 35-year-old man presents to the office for evaluation for anal itching and an episode of painless rectal bleeding. On examination, he has small hemorrhoidal skin tags. Office anoscopy shows grade I internal hemorrhoids. What is the initial treatment of choice?
- A healthy 41-year-old man presents to your office complaining of blood on the toilet paper after each bowel movement for the past 6 months. On anoscopy, grade II internal hemorrhoids with stigmata of bleeding are found. Which of the following is the most appropriate management?
- A 78-year-old man with atrial fibrillation seeks inpatient consultation for persistent bright red blood per rectum. He is hemodynamically stable. After holding anticoagulation, colonoscopy demonstrates internal hemorrhoids with stigmata of bleeding. What is the most appropriate next step in management?
- question 25
- Benign Disease