Extreme Uterine and Rectal Prolapse in a 31-Year-Old Patient: A Case Report

Abstract

Background: Pelvic organ prolapse (POP) is a common disorder among postmenopausal women but is rare in very young patients. It can affect various compartments of the pelvic floor. In severe forms, vaginal/uterine and rectal prolapse can occur concurrently. Methods: The aim of this report is to present a rare case of a young patient with an extreme postpartum uterine and rectal prolapse and our stepwise surgical approach to achieve complete repair while preserving the ability to carry future pregnancies. Results: A 31-year-old patient was admitted with extreme postpartum uterine and rectal prolapse. She underwent three separate surgeries to regain full anatomic reconstruction. Initially, laparoscopic lateral suspension (LLS) according to Dubuisson's technique was performed in 2017. A combined vaginal-laparoscopic repair followed again in 2017 and included extensive posterior vaginal and perineal repair with absorbable mesh (SeraSynth) attached to the sacrouterine ligaments and laparoscopic hysterosacropexy (HySa) with a non-absorbable PVDF DynaMesh-CESA implant. Finally, in 2019, the DynaMesh-CESA implant was replaced with a T-shaped non-absorbable Albis Posterior Mesh for rectal prolapse, fixed bilaterally to the sacral bone at the S3 level. Additionally, the Dubuisson suspension was adjusted using Noé's pectopexy for the implant's reattachment to the pectineal ligaments. Conclusions: Severe uterine and rectal prolapse in young patients is rare and demands a tailored approach. Uterus-preserving surgery should be the priority. In the present case, a resorbable posterior mesh failed in rectal prolapse repair, while a combined rectal prolapse repair and hysteropexy with a non-resorbable posterior mesh proved effective.

Keywords: pelvic organ prolapse; rectal prolapse; rectocele; total repair; uterine prolapse.

Figure 1

(A) Despite the first surgery in February 2017, a total uterine prolapse and rectal prolapse were pronounced at the patient’s admission to our institution in November 2017. (B) Partial improvement with a visible rectocele relapse after a vaginal resorbable mesh placement in the posterior compartment combined with a laparoscopic bilateral hysterosacropexy with a non-resorbable DynaMesh-CESA implant (performed November 2017) at a checkup in December 2018. (C) The final outcome: complete improvement after laparoscopic implantation of a non-resorbable mesh in the posterior compartment with fixation of this implant to the cervix and sacral bone, combined with the bilateral correction of the tension of lateral suspension mesh arms (performed in April 2019). Results stable as of December 2024.

Figure 2

MRI of pelvic organs in sagittal view. (A) Total uterine and rectal prolapse at the time of admission in November 2017. (B) Final outcome after treatment in April 2018. This anatomical picture remains stable as of December 2024.

Figure 3

Laparoscopic steps of the final (third) surgical procedure (April 2019). (A) Removal of the DynaMesh-CESA implant. (B) Placement of the Albis Posterior Mesh deep into the rectovaginal space. (C) Fixation of the Albis Posterior Mesh to the posterior cervical wall and bilaterally to the sacral bone. (D) Reattachment of the already present Dubuisson’s implant to the pectineal ligaments according to the uterine pectopexy technique described by Noé et al.