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Incarcerated urinary bladder in a rectal prolapse: A case report

Ningi AB, Aliyu M

Rectal prolapse is said to occur if there is a full-thickness intussusception of the rectal wall with external protrusion through the anus. It is a rare surgical presentation with an estimated prevalence of 0.5% worldwide. It is slightly commoner in females and the elderly, and women aged above 50 years have 6 times the risk of rectal prolapse than men. It is also seen in children younger than 4 years, mostly in the infancy stage. Excessive straining during defecation with or without constipation, diarrhea, malnutrition, helminthiasis, and prolonged use of laxatives are the main predisposing factors. It is part of a complex called the Pelvic Organ Prolapse (POP). It may therefore be associated with dysfunction and/or descent of other pelvic organs, e.g., rectoceles, uterine or vaginal vault prolapse, cystocele, and enterocoele. We previously reported a rare case of an incarcerated gravid uterus in rectal prolapse. Literature search, however, did not yield a single report of an incarcerated urinary bladder in rectal prolapse. This may probably be the first reported case in humans. The incarcerated prolapsed urinary bladder and the rectum were reduced via laparotomy, an encircling non-absorbable suture Thiersch procedure done on the anus and a proximal defunctioning colostomy sited because the rectal mucosa has questionable viability. No recurrence of rectal prolapse was recorded and the proximal sigmoid colostomy was reversed 6 weeks after the surgery.