A Case of Mucosal Prolapse Syndrome of the Rectrum

Mucosal prolapse syndrome (MPS) of the rectrum is manifested by protruding, ulcerative lesions in the rectal mucosa that result from the common condition of prolapsed rectal mucosa, and is characterized histologically by fibromusculosis of the lamina propria. As it has been shown that habitual constipation with straining is involved in the etiology of MPS, conservative treatment consists of instructing patients to improve their bowel habits, refrain from straining, and allow bowel rest. However, improving bowel evacuation habits is not easy, and local surgical resection is sometimes performed. We eliminated the ulcers associated with MPS in a 20-year-old woman by total parenteral nutrition (TPN).The course was uneventful without recurrence. The patient's main complaints were lower abdominal pain and chronic constipation with straining. Colonoscopy demonstrated MPS ulcers located 7 cm from the anal verge. Histologically, a slight thickening of the muscularis mucosa and fibromusculosis of the lamina propria were observed. Healing of the ulcers was achieved within four weeks after TPN. One year later, the patient's evacuation habits are still not satisfactory, but there has been no recurrence. As MPS is the cause of such ulcers, repairing the mucosal prolapse results in healing of the ulcers.

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