Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
Department of Precision and Translation Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
Pathologica. 2021 Dec;113(6):475-480. doi: 10.32074/1591-951X-253.
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.
直肠脱垂是一种直肠从肛门突出的疾病。孤立性直肠溃疡可能同时存在。这两种情况都与慢性便秘和排便时过度用力有关。直肠脱垂在患有神经性厌食症的女性中很少见。由于坐骨直肠脂肪丢失导致直肠缺乏支撑，这被认为是这种情况的可能机制之一，加上慢性便秘和滥用泻药。我们报告了一例患有严重直肠脱垂和出血的厌食症女性，需要紧急进行 Altmeier 手术。手术因吻合口裂开和肠扭转而复杂化，需要进行回肠造口术和皮瓣清创术。对从不同腹部部位取出的所有手术样本进行的病理分析显示，内脏脂肪组织发生变化，表现为小脂肪细胞的结节状聚集，分散在富含纤维的血管周围的黏液样基质中。形态特征类似于原始胎儿脂肪中观察到的特征，与癌症相关恶病质中观察到的特征相似。内脏脂肪组织弥漫性黏液样变性可能在神经性厌食症患者的直肠脱垂发病机制中起作用。除了饥饿之外，维持脂肪组织黏液样变性的机制尚不完全清楚。只要有可能，在进行任何手术之前，改善营养和临床状况应该是理想的。
