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Abstract
Image in medicine
A 45 years female presented with a complain of something coming out through her anus
since one year, which comes on straining and reduces only after manual intervention.
She had also, a history of constipation with occasional blood and mucus discharge
in the stool. On examination, she was found to have full thickness rectal prolapse,
which comes out on straining and reduces only after pushing it manually. With a diagnosis
of complete rectal prolapse grade III, she underwent abdominal suture rectopexy and
now she is doing well after six months of follow-up. One of the very close differential
diagnosis of complete rectal prolapse is prolapsed internal hemorrhoid. Both can present
with similar symptoms with similar clinical grading, but management is completely
different. Diagnosis of both these conditions is critical and mostly based on clinical
findings. The differentiating point between a rectal prolapse and internal hemorrhoid
lies in the orientation of the mucosal folds. Rectal prolase usually has circular
folds (A,B) where as internal hemorrhoids have radial folds (C). This is because,
hemorrhoids are collections of submucosal, fibrovascular, arterio-venous sinusoids
mostly seen in the left lateral, right anterolateral and right posterolateral region
of anal canal. While rectal prolapse is the intussusception of whole circumference
of the rectal wall through the anal canal which presents with circular folds of rectal
mucosa. This image presents a classic case of complete rectal prolapse with an image
of a prolapsed internal hemorrhoid to understand the differentiating points of these
two very common clinical conditions.
Figure 1
A) complete rectal prolapse with circular folds; B) lateral view of rectal prolapse
with circular folds; C) internal hemorrhoids at left lateral, right anterolateral
and right posterolateral regions with radial folds
Author and article information
Journal
Journal ID (nlm-ta): Pan Afr Med J
Journal ID (iso-abbrev): Pan Afr Med J
Journal ID (publisher-id): PAMJ
Title:
The Pan African Medical Journal
Publisher:
The African Field Epidemiology Network
ISSN
(Electronic):
1937-8688
Publication date
(Electronic):
27
May
2016
Publication date Collection: 2016
Volume: 24
Electronic Location Identifier: 88
Affiliations
[1
]Department of Surgery, AIIMS, Bhubaneswar, Odisha State, India
Author notes
[&
]Corresponding author: Susanta Meher, Department of Surgery, AIIMS, Bhubaneswar, Odisha
State, India
The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed
under the terms of the Creative Commons Attribution License which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly
cited.