repairing rectal prolapse, a large rectocele, vaginovesicocele and voluminous enterocele in a young nulliparous woman

Autori: M. Mongardini – A. Cola – R.P. Iachetta – E. Degli Effetti – D. Pichelli – P. Urciuoli – F. Custureri - APRILE 2007

Università degli Studi di Roma "La Sapienza" – Dipartimento di Scienze Chirurgiche – Azienda Policlinico Umberto I – ROMA

Presentato al:

• 3° Congresso Nazionale SIUCP e 2° World Congress of Coloproctology and Pelvic Diseases, Innovation and Current Debates – Roma, 18-20 giugno 2007;
• XVIII Congresso di Chirurgia dell’Apparato Digerente – Roma, 27-18 settembre 2007;
• 109° Congresso SIC – Verona, 14-17 ottobre 2007

A 27-year-old patient presented for investigation of a 3-year history of obstructed defecation (Wexner constipation score 20) and persistent tenesmus that severely curtailed her day-to-day activities and induced depression. The diagnostic work-up, including dynamic magnetic resonance imaging of the pelvic floor, anorectal manometry, vaginorectal-entero-defecography, pancolonoscopy, transrectal ultrasonography and electromyography, diagnosed rectal prolapse with recto-rectal intussusception, a large rectocele and voluminous enterocele (Douglas hernia), vaginovesicocele probably related to lax tissues and ligaments. Other specialist centers had advised combined rectocele and enterocele repair through the vaginal approach or, owing to the risk of postoperative dyspareunia, rectocele repair via an endorectal approach, without recourse to the stapler. When the patient came to our notice, considering her young age, and nulliparity, good physical conditions and distress (painful evacuations using enemas and digitation, at a mean frequency of 20 times a day) we planned a video-laparoscopically assisted STARR operation.

Laparoscopy disclosed a marked Douglas hernia occupying a large part of the sigmoid colon, which appeared enlarged. The uterus had completely prolapsed into the vagina. The uterus was laparoscopically returned to its normal position thus restoring normal anatomic relationships and the STARR prolapsectomy repaired the rectum (the gynecological consultants present advised against hysteropexy).