EP261 - Managing Rectal Prolapse with Intussuscepted Sigmoid in a Patient with Cognitive Impairment and Severe Cardiopulmonary Disease

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Purpose/Background: Rectal prolapse, the protrusion of the rectal mucosa or full-thickness rectal wall through the anal canal, can severely affect a patient's quality of life and often requires surgical intervention. While it can occur across various age groups, it is most prevalent in children, women, and the elderly, often linked to chronic constipation, multiparity, and pelvic floor dysfunction. This case report presents a rare instance of rectal prolapse with an associated polyp, highlighting the surgical management and treatment outcomes in a patient with complex comorbidities.

Methods/Interventions: A 55-year-old female with cognitive impairment, schizophrenia, heart failure, pulmonary hypertension, and severe chronic constipation presented with an irreducible rectal prolapse. Her history included recurrent rectal prolapse episodes over the previous four months. Initially, her family reported successful manual reduction of the prolapse. On physical examination, a 30 cm full-thickness rectal prolapse with an ulcerated and ischemic surface, accompanied by a prolapsed polyp, was identified.
An Altemeier procedure was planned; however, during surgery, sigmoid intussusception was discovered, prompting a switch to an abdominal approach. Surgical findings revealed a 6x3x3 cm polypoid mass with transanal prolapse of the sigmoid colon. The patient underwent an extended left hemicolectomy with total mesorectal excision and colostomy construction.

Results/Outcomes: Rectal prolapse is commonly associated with redundant sigmoid colon, pelvic floor dysfunction, and chronic constipation. Risk factors include multiparity, advanced age, and chronic constipation. The prolapse can range from mucosal to full-thickness and may involve polyps. Treatment is influenced by patient-specific factors such as age, overall health, and symptom severity. In cases like this, where the prolapse is large and irreducible, surgical resection of the redundant bowel is necessary. The patient’s surgery was successful, with no recurrence, demonstrating that timely surgical intervention can lead to favorable long-term outcomes.

Conclusion/Discussion: Giant rectal prolapse, though rare, can severely impact quality of life, particularly when complicated by chronic constipation. Prompt surgical intervention is critical in preventing complications and improving outcomes. The choice of surgical approach should be tailored to the patient's condition, considering factors such as bowel redundancy and overall health. In this case, abdominal resection successfully resolved the prolapse without recurrence. Surgical intervention remains the definitive treatment for irreducible prolapse, with patient adherence and surgical expertise being key to achieving positive outcomes.