Severe anemia by rectal prolapse.

A 57 year old woman, with no known allergies, a history of excessive alcohol consumption and a previous diagnosis of compensated alcoholic cirrhosis of the liver, was admitted because of intermittent rectal bleeding and severe anaemia ( Hb: 5 gr/dl). Physical examination showed a large rectal prolapse (Fig 1). After reducing the prolapse, a colonoscopy was performed and no other abnormalities were found. We also performed an anal endosonography that showed sphincter changes secondary to longstanding complete rectal prolapse, without disruption at any level. A surgical treatment was decided and it consisted in rectal wall section 1.5 cm. above the dentate line, opening of the anterior pelvic peritoneum and circumferential section of the meso with ligature and haemostatic suture. After separating the vaginal wall, the redundant peritoneum was excised and was fixed to the colon. Furthermore, a four sutures levator muscle anterior plasty and a manual coloanal anastomosis were performed.