Iatrogenic Rectal Diverticulum With Pelvic-Floor Dysfunction in Patients After a Procedure for a Prolapsed Hemorrhoid

Abstract

Diverticula are frequently seen in the sigmoid, descending, ascending and transverse colons whereas rectal diverticula are extremely rare. The stapled rectal mucosectomy for the treatment of a prolapsed hemorrhoid is less painful and has lower morbidity; therefore, it has been commonly used despite possible complications. This paper reports a case of a rectal diverticulum that developed after a procedure for prolapsed hemorrhoids (PPH). A 42-year-old man with a history of hemorrhoidectomies came to the hospital because of constipation. On sigmoidoscopy, a 2-cm-sized, feces-filled pocket was located just above the anorectal junction. After removal of the fecal material, a huge rectal diverticulum (-4 cm in diameter) was seen. Pelvic magnetic resonance imaging (MRI) confirmed the diagnosis of rectal diverticulum outpouching through the muscular layer of the intestine in a left posterolateral direction. The patient was discharged without complication after a transanal diverticulectomy had been performed, and the direct rectal wall had been repaired.

A case of solitary rectal diverticulum presenting with a large retrorectal abscess

“…To our knowledge, sciatic neuropathy and bilateral obstructive uropathy, as in our case, have never been reported before. Asymptomatic patients do not require treatment, whereas symptomatic rectal diverticulosis necessitates surgical intervention, if possible [2,3,7,8]. Acute excision or drainage of the diverticulum was not possible in our case, since the diverticular walls were spoilt, thus making the definitive surgical treatment of the diverticulum extremely dangerous.…”

“…Colonic diverticula are acquired herniations of the mucosa and part of the submucosa through the muscularis propria. Diverticula are more frequently seen in the distal colon, with the sigmoid colon being affected in 90% of the patients [[1], [2], [3]].…”

“…In contrast, rectal diverticular disease is a rare condition with very few cases reported. They make up solely for 0.1% of colonic diverticular disease [1,2]. Two major theories about the low incidence of rectal diverticulosis have been reported.…”

“…According to the current literature, rectal diverticulosis applies for 0.1% of the cases of colonic diverticulosis. The vast majority of patients with rectal diverticula are diagnosed incidentally; symptomatic rectal diverticula are very rare [1,2]. We report an isolated rectal diverticulum, which presented with a large retrorectal abscess.…”

Mucocele complicating stapled hemorrhoidopexy

“…Incision and drainage to create a wide connection between mucocele and rectal lumen is usually enough, but muosal eversion may be associated to reduce the recurrence. Diverticulectomy with direct rectal wall repair has been recently reported to treat rectal pocket [10] even if our more conservative surgery remains a feasible solution. In case of pararectal lesion a different approach could be used according to the position, dimension and oncological target.…”