Cases
A 98 year-old female from a nursing home, presented with recurrent
symptomatic rectal prolapse after a Delorme’s procedure seven months
prior. Her past medical history includes Alzheimer’s disease and
vascular dementia, hypertension, hypercholesterolaemia, congenital
cardiac failure, paroxysmal atrial fibrillation, osteoporosis and
recurrent falls.
Despite being considered for abdominal rectopexy, urogynaecology review
was sought for second opinion. There was no vaginal prolapse on
examination. An oval vaginal pessary was trialled (Figure 1). She is
currently on vaginal estrogen cream twice per week with a plan to change
the pessary every 2-3 months. Eight months later, the patient continues
to comfortably open her bowels without rectal prolapse or vaginal
discharge or bleeding.
The second patient is a 78 year-old woman who presented with severe
rectal pain, recurrent rectal prolapse, constipation and associated
urinary retention.
Past medical history included a Delorme’s procedure 3 years ago,
anterior vaginal wall repair, refractory chronic idiopathic
thrombocytopenia purpura secondary to splenectomy, degenerative spinal
disease with canal stenosis and neuropathy requiring laminectomy and
spinal fusion, dyslipidaemia, asthma, Grave’s disease, osteoporosis,
osteoarthritis and recurrent falls.
On examination, the patient had a 4cm rectal prolapse outside the anal
verge, without a vaginal prolapse. A size 4 Sayco oval pessary with
support was fitted. Four months after placement, the patient reported
good bowel motions, nil rectal prolapse recurrence, nil urinary
retention and nil vaginal discharge or bleeding.
The third patient is a 93 year-old woman who presented with recurrence
of her rectal prolapse following a Delorme’s procedure two years ago.
Her rectal prolapse did not recur since pessary insertion 6 months ago.