Successful Surgical Repair of Anterior Rectocele in Patient With Constipation

CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. *Correspondence: Moo In Park, MD Department of Internal Medicine, Kosin University College of Medicine, 262, Gamcheon-ro, Seo-gu, Busan 602-702, Korea Tel: +82-51-990-6719, Fax: +82-51-990-5055, E-mail: [email protected] Financial support: None. Conflicts of interest: None. A 56-year-old female visited our department because of the constipation over 30 years. In addition, intermittent cramping abdominal pain was combined in recent 6 months. Despite of the combination of prokinetics, bulking agents and osmotic laxatives, the frequency of defecation was about once every 4 to 7 days, and she performed digital vaginal pressure to defecate. Laboratory findings, plain abdominal radiography, colonoscopy and abdominal computed tomography were unremarkable. Colon transit time was within the normal range. Eventually, about 5 cm sized anterior rectocele was detected on fluoroscopic defecography (Figure A and D). We treated with medication and biofeedback therapy. However, constipation was not improved for 6 months and even the size of rectocele was increased to 5.5 cm on the follow-up defecography (Figure B and E). Therefore, she underwent rectocele repair with colporrhaphy. About 6 months after surgery, the size of rectocele was decreased to 2 cm on follow-up defecography (Figure C and F). When we evaluated symptom response before and after the surgery using Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ-22), the score of constipation and evacuation was decreased. And, she could defecate daily without abdominal pain. Rectocele is a herniation of the rectal wall that often becomes apparent during defecation. Rectocele is common in adult women (20%), and most of it is small (< 2 cm), asymptomatic, therefore treatment is not necessary. However, surgery is suitable for patients in whom large rectocele (> 3 or 4 cm) or those with coexisting vaginal prolapse is present in spite of adequate medication. Thus, surgical treatment could be considered in some patients with rectocele.