Rectal prolapse is a disorder in which the rectum protrudes from the anal canal. Solitary rectal ulcer may coexist. Both conditions have been associated with chronic constipation and excessive straining during defecation. Rectal prolapse has been rarely reported in women suffering from anorexia nervosa. Lack of rectal support because of loss of ischiorectal fat has been proposed as one of the possible mechanisms in this condition, together with chronic constipation and abuse of laxative. We report the case of an anorexic woman with a severe rectal prolapse and bleeding requiring urgent Altmeier's procedure. Surgery was complicated by dehiscence of the anastomosis and volvulus, requiring ileostomy and laciniae debridement. Pathological analysis of all the surgical samples taken from different abdominal sites highlighted changes in the visceral adipose tissue consisting in nodular aggregates of small adipocytes dispersed in a myxoid matrix surrounding blood vessels within abundant fibrosis. The morphologic features resemble those observed in primordial fetal fat and are comparable to those observed in cancer associated cachexia. The diffuse myxoid degeneration of visceral adipose tissue may play a role in the pathogenesis of rectal prolapse in patients with anorexia nervosa. Besides starvation, the mechanism sustaining myxoid degeneration of the adipose tissue is not entirely clear. Whenever possible improving nutritional and clinical conditions should be ideal before any surgical approach.

Severe rectal prolapse and solitary rectal ulcer in a young anorectic woman with myxoid degeneration of visceral adipose tissue / Vescovo, Mariavittoria; Pesci, Ludovica; Lapenna, Lucia; De Santis, Emanuela; Di Nardo, Domenico; de Anna, Livia; Mongardini, Federico Maria; Ascoli, Valeria; Mongardini, Massimo; De Santis, Adriano; Giordano, Carla. - In: PATHOLOGICA. - ISSN 1591-951X. - 113:6(2021), pp. 475-480. [10.32074/1591-951X-253]

Severe rectal prolapse and solitary rectal ulcer in a young anorectic woman with myxoid degeneration of visceral adipose tissue

Vescovo, Mariavittoria
Primo
;
Pesci, Ludovica
Secondo
;
Lapenna, Lucia;De Santis, Emanuela;Di Nardo, Domenico;de Anna, Livia;Ascoli, Valeria;Mongardini, Massimo;De Santis, Adriano
Penultimo
;
Giordano, Carla
Ultimo
2021

Abstract

Rectal prolapse is a disorder in which the rectum protrudes from the anal canal. Solitary rectal ulcer may coexist. Both conditions have been associated with chronic constipation and excessive straining during defecation. Rectal prolapse has been rarely reported in women suffering from anorexia nervosa. Lack of rectal support because of loss of ischiorectal fat has been proposed as one of the possible mechanisms in this condition, together with chronic constipation and abuse of laxative. We report the case of an anorexic woman with a severe rectal prolapse and bleeding requiring urgent Altmeier's procedure. Surgery was complicated by dehiscence of the anastomosis and volvulus, requiring ileostomy and laciniae debridement. Pathological analysis of all the surgical samples taken from different abdominal sites highlighted changes in the visceral adipose tissue consisting in nodular aggregates of small adipocytes dispersed in a myxoid matrix surrounding blood vessels within abundant fibrosis. The morphologic features resemble those observed in primordial fetal fat and are comparable to those observed in cancer associated cachexia. The diffuse myxoid degeneration of visceral adipose tissue may play a role in the pathogenesis of rectal prolapse in patients with anorexia nervosa. Besides starvation, the mechanism sustaining myxoid degeneration of the adipose tissue is not entirely clear. Whenever possible improving nutritional and clinical conditions should be ideal before any surgical approach.
2021
adipose tissue; anorexia; fetal fat; myxoid degeneration; rectal prolapse; female; humans; intra-abdominal fat; Ulcer; appetite depressants; rectal diseases; rectal prolapse
01 Pubblicazione su rivista::01i Case report
Severe rectal prolapse and solitary rectal ulcer in a young anorectic woman with myxoid degeneration of visceral adipose tissue / Vescovo, Mariavittoria; Pesci, Ludovica; Lapenna, Lucia; De Santis, Emanuela; Di Nardo, Domenico; de Anna, Livia; Mongardini, Federico Maria; Ascoli, Valeria; Mongardini, Massimo; De Santis, Adriano; Giordano, Carla. - In: PATHOLOGICA. - ISSN 1591-951X. - 113:6(2021), pp. 475-480. [10.32074/1591-951X-253]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1602056
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