PMC6370581_01
Physical exam in lithotomy position showing vaginal prolapse (arrow) and full-thickness rectal prolapse (asterisk).
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On physical exam, the patient was noted to have stage 3 anterior vaginal wall prolapse (Ba = +3), stage 2 apical prolapse (C = 0), posterior wall prolapse (Bp = -1), and full-thickness rectal prolapse, more prominent anteriorly (Fig. 1).
Single sagittal midline T2-weighted Fast Spin Echo (FSE) image with the patient at rest demonstrates complete anorectal prolapse (solid arrows) containing the bladder (B) and peritoneal fat (*). The bladder is also seen prolapsing though the vagina in the middle compartment (dashed arrow). PS - pubic symphysis; U - urethra; S - sacrum.
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MR imaging of the pelvis was performed (Fig. 2), which showed an anterior cystocele component protruding through the vaginal introitus extending 4.5 cm below the pubococcygeal line (PCL) as well as a posterior cystocele component extending 9 cm below the PCL protruding through a complete extra-anal rectal prolapse, beyond the level of the anal verge.