PMC10129352_01
Appearance of the rectal prolapse. a) At the time of the first visit. b) During surgery.
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A 79-year-old woman was referred from another hospital for full-thickness RP measuring 4 cm in length (Figure 1a). Intraoperative evaluation revealed that the RP had worsened to >10 cm in length (Figure 1b).
Rectal mobilization (laparoscopic view). a) Dissection between the fascia propria of the rectum (FPR) and the pre-hypogastric fascia (PHF) at the rectosigmoid level; the right hypogastric nerve (blue asterisk) crossed the presacral areolar tissue and adhered to the FPR. b) Sticky membranous adhesions were observed between FPR and PHF. c) Moist snowy appearance of the loose connective tissue (red asterisk) was observed below the lower layer of the rectosacral fascia (RSF) (red dashes). d) There was a serum-like exudate suggestive of serous inflammation in the right margin of the RSF. The blue triangle shows the fascial-fusion zone (lateral rectal ligament [LRL]).
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Figure 2a-d show a laparoscopic view during rectal mobilization:with marked edema and rough and membranous adhesions noted in the retrorectal space:between the fascia propria of the rectum and the pre-hypogastric fascia, especially above the upper layer of the rectosacral fascia.
Computed tomography (CT) attenuation values were obtained by drawing an elliptical region of interest on a CT scan at four points in the mesorectum and the abdominal subcutaneous fat. a) S4 axial image. b) Midsagittal image.
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The CT attenuation values around the rectum were analyzed by drawing an elliptical region of interest and compared with those recorded in the abdominal subcutaneous fat (Figure 3a, 3b). The CT attenuation values were found to be higher in the mesorectum versus the subcutaneous fat, especially in the posterior area of the mesorectum (P < 0.05) (Figure 4a, 4b).
Distribution of computed tomography (CT) attenuation values. a) Axial view at the level of the lower margin of the fourth sacral vertebrae. b) At the midsagittal level. The red circles indicate the average CT attenuation values. HU, Hounsfield units
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The CT attenuation values around the rectum were analyzed by drawing an elliptical region of interest and compared with those recorded in the abdominal subcutaneous fat (Figure 3a, 3b). The CT attenuation values were found to be higher in the mesorectum versus the subcutaneous fat, especially in the posterior area of the mesorectum (P < 0.05) (Figure 4a, 4b).