Rectal prolapse

Rectal prolapse
Diagnosis in short
Fibromuscular hyperplasia as seen in rectal prolapse. H&E stain.
LM	fibromuscular hyperplasia: lamina propria fibrosis and muscle, thick muscularis propria, +/-ischemic changes
Site	rectum
Clinical history	women - multiparous & postmenopausal
Signs	"rectal mass"
Prevalence	not common
Prognosis	benign
Clin. DDx	rectal carcinoma (rarely)
Treatment	surgery

Rectal prolapse is a benign pathology of the rectum, typically seen in women that are multiparous and postmenopausal.

General

• Usually close to the anal verge.
• Rare forms can occasionally be confused with cancer.

Epidemiology:

• ~90% women, postmenopausal and multiparous.

Treatment:

• Surgical:
  • Delorme procedure = mucosa stripped.

Microscopic

Features:

• "Fibromuscular hyperplasia" - key feature:
  • Fibrosis (submucosa, lamina propria).
  • Muscularis mucosae is "too superficial" (muscle in the lamina propria).
• Surface ulceration + inflammation (neutrophils).
  • May show frank ischemic changes - see ischemic colitis.
• +/-Serration of epithelium at the surface.

Notes:

• Important negative: no nuclear atypia.
  • May be seen if ischemic changes are present.

Images

• 

  Rectal prolapse - low mag. (WC/Nephon)

• 

  Rectal prolapse - intermed. mag. (WC/Nephron)

Sign out

RECTAL MUCOSA, DELORME PROCEDURE:
- SUPERFICIAL RECTAL WALL WITH FIBROMUSCULAR HYPERPLASIA AND EDEMA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. 

Micro

The sections show rectal mucosa, submucosa and a small amount of muscularis propria. The mucosa shows fibromuscular hyperplasia with thickening of the muscularis mucosae and mild lamina propria fibrosis. The submucosa is edematous. The small amount of muscularis propria is unremarkable. The epithelium matures normally to the surface. No significant nuclear atypia is identified.

See also

• Rectum.
• Solitary rectal ulcer.