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Rectal Prolapse and Intussusception
Atif Zaheer, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Rectosigmoid intussusception
              • Proximal rectum ± sigmoid telescopes into distal rectum, rarely through anus
              • Invagination of full thickness of rectal wall in towards rectal wall
              • 3 types: Intrarectal, intraanal, extraanal (rectal prolapse)
            • Partial prolapse (type 1)
              • Rectal mucosa protrudes no more than 2 cm below anus
            • Total prolapse (procidentia, type 2)
              • All layers of rectum protrude
              • May include hernia sac of peritoneum ± other bowel segments
            • Rectal ulcer syndrome
              • Traumatic or ischemic ulceration of rectal mucosa associated with disordered evacuation
              • 95% of affected patients have internal intussusception

          IMAGING

          • General Features

            • Imaging Recommendations

              • Radiographic Findings

                • MR Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Treatment

                            Selected References

                            1. Sakala MD et al: Advances in MR imaging of the female pelvis. Magn Reson Imaging Clin N Am. 28(3):415-31, 2020
                            2. Swamy N et al: Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification. Abdom Radiol (NY). ePub, 2020
                            3. Lakhoo J et al: MRI of the male pelvic floor. Radiographics. 39(7):2003-22, 2019
                            4. Forootan M et al: Solitary rectal ulcer syndrome: a systematic review. Medicine (Baltimore). 97(18):e0565, 2018
                            5. Joubert K et al: Abdominal approaches to rectal prolapse. Clin Colon Rectal Surg. 30(1):57-62, 2017
                            6. Can MF et al: Laparoscopic resection rectopexy with preservation of the superior rectal artery, natural orifice specimen extraction, and assessment of anastomotic perfusion using indocyanine green imaging in rectal prolapse. Dis Colon Rectum. 57(12):1441, 2014
                            7. Ellington D et al: Pelvis floor symptoms and quality of life analyses in women undergoing surgery for rectal prolapse. World J Colorectal Surg. 3(3), 2013
                            8. Colaiacomo MC et al: Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics. 29(3):e35, 2009
                            9. Law YM et al: MRI of pelvic floor dysfunction: review. AJR Am J Roentgenol. 191(6 Suppl):S45-53, 2008
                            10. Tou S et al: Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. (4):CD001758, 2008
                            11. Singh B et al: Histopathological mimicry in mucosal prolapse. Histopathology. 50(1):97-102, 2007
                            12. Hetzer FH et al: MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology. 240(2):449-57, 2006
                            13. Macura KJ: Magnetic resonance imaging of pelvic floor defects in women. Top Magn Reson Imaging. 17(6):417-26, 2006
                            14. Dvorkin LS et al: Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers. Br J Surg. 92(7):866-72, 2005
                            15. Madiba TE et al: Surgical management of rectal prolapse. Arch Surg. 140(1):63-73, 2005
                            16. Pomerri F et al: Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR Am J Roentgenol. 176(3):641-5, 2001
                            17. Salzano A et al: [The defecographic and clinical aspects of the solitary rectal ulcer syndrome.] Radiol Med. 95(6):588-92, 1998
                            18. Bremmer S et al: Defaeco-peritoneography in the diagnosis of rectal intussusception and rectal prolapse. Acta Radiol. 38(4 Pt 1):578-83, 1997
                            19. Agachan F et al: Defecography and proctography. Results of 744 patients. Dis Colon Rectum. 39(8):899-905, 1996
                            20. Goei R et al: Rectal intussusception and rectal prolapse: detection and postoperative evaluation with defecography. Radiology. 174(1):124-6, 1990
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Pathology

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Definitions

                                      • Rectosigmoid intussusception
                                        • Proximal rectum ± sigmoid telescopes into distal rectum, rarely through anus
                                        • Invagination of full thickness of rectal wall in towards rectal wall
                                        • 3 types: Intrarectal, intraanal, extraanal (rectal prolapse)
                                      • Partial prolapse (type 1)
                                        • Rectal mucosa protrudes no more than 2 cm below anus
                                      • Total prolapse (procidentia, type 2)
                                        • All layers of rectum protrude
                                        • May include hernia sac of peritoneum ± other bowel segments
                                      • Rectal ulcer syndrome
                                        • Traumatic or ischemic ulceration of rectal mucosa associated with disordered evacuation
                                        • 95% of affected patients have internal intussusception

                                    IMAGING

                                    • General Features

                                      • Imaging Recommendations

                                        • Radiographic Findings

                                          • MR Findings

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • General Features

                                                CLINICAL ISSUES

                                                • Presentation

                                                  • Demographics

                                                    • Treatment

                                                      Selected References

                                                      1. Sakala MD et al: Advances in MR imaging of the female pelvis. Magn Reson Imaging Clin N Am. 28(3):415-31, 2020
                                                      2. Swamy N et al: Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification. Abdom Radiol (NY). ePub, 2020
                                                      3. Lakhoo J et al: MRI of the male pelvic floor. Radiographics. 39(7):2003-22, 2019
                                                      4. Forootan M et al: Solitary rectal ulcer syndrome: a systematic review. Medicine (Baltimore). 97(18):e0565, 2018
                                                      5. Joubert K et al: Abdominal approaches to rectal prolapse. Clin Colon Rectal Surg. 30(1):57-62, 2017
                                                      6. Can MF et al: Laparoscopic resection rectopexy with preservation of the superior rectal artery, natural orifice specimen extraction, and assessment of anastomotic perfusion using indocyanine green imaging in rectal prolapse. Dis Colon Rectum. 57(12):1441, 2014
                                                      7. Ellington D et al: Pelvis floor symptoms and quality of life analyses in women undergoing surgery for rectal prolapse. World J Colorectal Surg. 3(3), 2013
                                                      8. Colaiacomo MC et al: Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics. 29(3):e35, 2009
                                                      9. Law YM et al: MRI of pelvic floor dysfunction: review. AJR Am J Roentgenol. 191(6 Suppl):S45-53, 2008
                                                      10. Tou S et al: Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. (4):CD001758, 2008
                                                      11. Singh B et al: Histopathological mimicry in mucosal prolapse. Histopathology. 50(1):97-102, 2007
                                                      12. Hetzer FH et al: MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology. 240(2):449-57, 2006
                                                      13. Macura KJ: Magnetic resonance imaging of pelvic floor defects in women. Top Magn Reson Imaging. 17(6):417-26, 2006
                                                      14. Dvorkin LS et al: Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers. Br J Surg. 92(7):866-72, 2005
                                                      15. Madiba TE et al: Surgical management of rectal prolapse. Arch Surg. 140(1):63-73, 2005
                                                      16. Pomerri F et al: Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR Am J Roentgenol. 176(3):641-5, 2001
                                                      17. Salzano A et al: [The defecographic and clinical aspects of the solitary rectal ulcer syndrome.] Radiol Med. 95(6):588-92, 1998
                                                      18. Bremmer S et al: Defaeco-peritoneography in the diagnosis of rectal intussusception and rectal prolapse. Acta Radiol. 38(4 Pt 1):578-83, 1997
                                                      19. Agachan F et al: Defecography and proctography. Results of 744 patients. Dis Colon Rectum. 39(8):899-905, 1996
                                                      20. Goei R et al: Rectal intussusception and rectal prolapse: detection and postoperative evaluation with defecography. Radiology. 174(1):124-6, 1990