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Rectal Intussusception (Internal rectal prolapse)

What is intussusception?

This is a term that denotes that one part of the bowel will slide inside another part of the bowel so that there will be a tube inside a tube.

When this happens in the rectum it is called internal rectal intussusception

Types of rectal intussusception

rectal intussusception can be broadly divided into high type (recto rectal) and low type (recto anal).

What is the significance?

This is not always clear. Intussusception (high type) can be found in asymptomatic normal volunteers undergoing defaecation proctography. However, the low type is not uncommonly associated with obstructed defaecatory symptoms. In many patients there is an associated rectocoele as well

Which is more important, an intussusception or a rectocoele?

This is usually difficult to tell. Defaecation proctography may suggest that intussusception may descend low enough to impede further defaecation or may suggest that a large functional rectocoele may actually contribute more to the difficulties with evacuation.

Careful patient history and examination likewise may shed light on whether both intussusception and rectocoele contribute to the difficulty with evacuation or whether one is more important. At the end the experienced coloproctologist has to make an informed judgment on what is more important and thus recommend a particular course of treatment


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Clinical diagnosis

Dynamic proctography

Associated pelvic floor disorders





Stop straining


Surgical treatment

Surgical treatment of obstructive defaecation is still in its infancy. The number of studies evaluating different approaches is small and the number of patients treated in each series is also small. Pioneering surgeons in the field hold strong views on one approach or another, without strong evidence in most cases. Patients need to be made aware of the different options and should be involved fully in the discussion prior to surgery, emphasizing that these procedures may improve, but not necessarily cure obstructive defaecatory symptoms altogether. It is also very important to emphasize what is being treated here, which is an anatomical abnormality that appear to interfere with the mechanics of defaecation. Surgery can not be expected to change disordered sensation and thus may not

1. Intra-anal Delorme's Procedure

This is possible in patients with really low recto anal intussusception, but it is a difficult procedure to perform. I had a reasonable success with it, with about 60% of patients reporting improvement in symptoms

2. Abdominal rectopexy

Abdominal rectopexy alone has

3. Abdominal rectopexy & anterior resection (sometimes with colposuspension)

Abdominal rectopexy & anterior resection (sometimes with colposuspension) is my current preferred option and most of these can be done laparoscopically. This deals directly with the internally prolapsed rectum, can treat enterococeles simultaneously by lifting the pouch of Douglas upwards and can also treat vaginal vault prolapse by incorporating colpopexy. It can be done using sutures or a mesh and in most patients addition of segmental sigmoid resection (high anterior resection), prevent acute bowel angulation afterwards, which may cause obstructive defaecation symptoms

4. Express procedure (Norman Williams)


Postoperative advice










Deya Marzouk, Consultant Surgeonscalpel pix