Extensive anorectal condyloma presenting with rectal prolapse

Hanan M AlGhamdi; Shyam K Parashar; Saleem Khwaja; Mona H Ismail; Zeead M AlGhamdi

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CASE REPORT

Year : 2008 \| Volume : 29 \| Issue : 1 \| Page : 34-36

Extensive anorectal condyloma presenting with rectal prolapse

Hanan M AlGhamdi¹, Shyam K Parashar¹, Saleem Khwaja¹, Mona H Ismail², Zeead M AlGhamdi¹
¹ Department of Surgery, King Fahad Hospital of the University, Dammam, Saudi Arabia
² Department of Internal Medicine, King Fahad Hospital of the University, Dammam, Saudi Arabia

Correspondence Address:
Hanan M AlGhamdi
Department of Surgery, P.O. Box 40020, AlKhobar 31952
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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Abstract

Complete rectal prolapse (full-thickness, circumferential intussusception of the entire rectal wall through the anal canal) is not a common condition. Furthermore, anorectal giant condyloma acuminata (ConA), a sexually transmitted disease caused by human papilloma viruses, is rarely reported as a cause of rectal prolapse or as occurring in association with it. We report a patient with extensive anorectal ConA who had recurrent rectal prolapse, which became irreducible and required urgent surgery for reduction and perianal and abdominal rectopexy.

Keywords: Condyloma acuminata, human papilloma viruses, rectal prolapse

How to cite this article:
AlGhamdi HM, Parashar SK, Khwaja S, Ismail MH, AlGhamdi ZM. Extensive anorectal condyloma presenting with rectal prolapse. Indian J Sex Transm Dis 2008;29:34-6

How to cite this URL:
AlGhamdi HM, Parashar SK, Khwaja S, Ismail MH, AlGhamdi ZM. Extensive anorectal condyloma presenting with rectal prolapse. Indian J Sex Transm Dis [serial online] 2008 [cited 2023 Dec 10];29:34-6. Available from: https://ijstd.org/text.asp?2008/29/1/34/42714

Introduction

A 51-year-old woman, mother of six children, presented to us with a history of extensive perianal and vaginal condyloma acuminata (ConA) for 15 years (proved by microbiology, immunology, and histology to be due to human papilloma virus (HPV)) with occasional concomitant candidal infection. She had received different local and systemic treatment for the ConA and candida (topical podophyllin resin 10%, NSAIDs, systemic antibiotics, and fluconazole) but the perianal ConA persisted [Figure 1A]. She also gave a history of recurrent mild rectal bleeding that had become heavier in the last year and complained about tenesmus and the occasional appearance of a reducible anal mass on straining. She underwent frequent colonoscopic examinations; all showed extensive ConA involving the lower rectum and perianal region. A recent colonoscopy showed a large (2 × 4 cm) posterior rectal ulcer, 20 cm from the anal verge, with scattered polypoid lesions adjacent to it; there was also extensive ConA, with nonspecific chronic and acute inflammatory changes but no malignant features on biopsy [Figure 1B]. While in hospital for workup, the patient developed rectal prolapse on straining. On evaluation, the rectal prolapse was complete and irreducible [Figure 2]. The edematous rectum could only be reduced through a lower abdominal laparotomy done under general anesthesia. The grossly patulous anus was repaired with Thiersch's procedure [Figure 3]; rectosigmoidopexy, using prolene mesh, was done for the redundant rectum and, finally, the perianal condyloma was fulgurated by diathermy. The tissue histology was consistent with ConA with no suggestion of malignancy. She had uneventful postoperative course and was discharged on the 8^th postoperative day; she was advised topical podophyllin paint. During the 6 months' follow-up, she had complete healing of the perianal ConA and no per rectal bleeding or rectal prolapse. Follow-up colonoscopy showed remarkable resolution of her anorectal ConA and only a small remnant ulcer, with no malignant features, on biopsy [Figure 4].

Discussion

The precise cause of rectal prolapse is not fully defined; however, a number of associated abnormalities and conditions have been described. As many as 50% of prolapse cases are caused by chronic straining during defecation, constipation, and increased intra-abdominal tone due to other causes. A deep pouch of Douglas, weakness of the pelvic floor, decreased resting anal sphincter tone, neurological disorders, and some parasitic infections (amebiasis and schistosomiasis) also have been described as predisposing factors for rectal prolapse.^[1]

Management of an irreducible or recurrent complete prolapse of the rectum can be through a perineal approach or through a combined perineal and lower abdominal approach.^[2]

ConA (warts) is generally a sexually transmitted disease of adults caused by HPV (usually type 6 and 11 double-stranded DNA viruses that replicate in squamous epithelial cells). It occurs mainly in the genital and perianal areas (moist areas) and only rarely in the rectum.^[3] The lesion may progress into large papillomatous proliferations called condylomata gigantean or Buschke-Lowenstein tumor that penetrates deep into the underlying tissue.^{[4],[5],[6],[7],[8]}

This case report demonstrates some of the problems in caring for patients with ConA and the consequences of the condition. The importance of aggressive extirpation therapy was not appreciated until very late in the course of the disease in this patient. The presence of giant condyloma acuminata and its association with rectal prolapse is rarely recognized in the literature.

References

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