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. 2014 Feb;30(1):50-3.
doi: 10.3393/ac.2014.30.1.50. Epub 2014 Feb 28.

Iatrogenic rectal diverticulum with pelvic-floor dysfunction in patients after a procedure for a prolapsed hemorrhoid

Sun Kyung Na  1 , Hye-Kyung Jung  1 , Ki-Nam Shim  1 , Sung-Ae Jung  1 , Soon Sup Chung  2
Affiliations

Iatrogenic rectal diverticulum with pelvic-floor dysfunction in patients after a procedure for a prolapsed hemorrhoid

Sun Kyung Na et al. Ann Coloproctol. 2014 Feb.

Abstract

Diverticula are frequently seen in the sigmoid, descending, ascending and transverse colons whereas rectal diverticula are extremely rare. The stapled rectal mucosectomy for the treatment of a prolapsed hemorrhoid is less painful and has lower morbidity; therefore, it has been commonly used despite possible complications. This paper reports a case of a rectal diverticulum that developed after a procedure for prolapsed hemorrhoids (PPH). A 42-year-old man with a history of hemorrhoidectomies came to the hospital because of constipation. On sigmoidoscopy, a 2-cm-sized, feces-filled pocket was located just above the anorectal junction. After removal of the fecal material, a huge rectal diverticulum (-4 cm in diameter) was seen. Pelvic magnetic resonance imaging (MRI) confirmed the diagnosis of rectal diverticulum outpouching through the muscular layer of the intestine in a left posterolateral direction. The patient was discharged without complication after a transanal diverticulectomy had been performed, and the direct rectal wall had been repaired.

Keywords: Diverticulum; Hemorrhoidectomy; Prolapsed hemorrhoids.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Sigmoidoscopy at diagnosis. (A) The pocket was located just above the anorectal junction and was filled with feces. (B) After removal of the fecal material, a huge rectal diverticulum was seen.
Fig. 2
Fig. 2
Rectal manometry at diagnosis; defecation index = 0.9, rectal and anal pressure were elevated (pelvic-floor dysfunction, type 1).
Fig. 3
Fig. 3
Defecography showed the filling defect with broad base at anterior wall of rectum leads to lumen narrowing.
Fig. 4
Fig. 4
The transverse (A) and the coronal (B) images on pelvic magnetic resonance imaging showed a rectal diverticulum outpouching through the muscular layer of the intestine (arrow).
See this image and copyright information in PMC

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