Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
Indian J Sex Transm Dis
The Journal | Search | Ahead Of Print | Current Issue | Archives | Instructions | Subscribe | Login    Users online: 1480   Home Email this page Print this page Bookmark this page Decrease font size Default font size Increase font size


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

Extensive anorectal condyloma presenting with rectal prolapse


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
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

 

   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 2019 Nov 19];29:34-6. Available from: http://www.ijstd.org/text.asp?2008/29/1/34/42714



   Introduction Top


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 Top


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 Top

1.Andrews NJ, Jones DJ. Rectal proplapse and associated conditions. BMJ 1992;305:243-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Azimuddin K, Khubchandani IT, Rosen L, Stasik JJ, Riether RD, Reed JF 3rd. Rectal prolapse: A search for the "Best" operation. Am Surg 2001;67:622-7.  Back to cited text no. 2  [PUBMED]  
3.Wiley DJ, Douglas J, Beutner K, Cox T, Fife K, Moscicki AB, et al . External genital warts: Diagnosis, treatment and prevention. Clin Infect Dis 2002;35:S210-24.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Jensen LS, Falstie-Jensen S. Giant condyloma acuminatum or Buschke-Lowenstein's tumor. Description of a case localized to the rectum. Ugeskr Laeger 1984;146:2875-6.  Back to cited text no. 4    
5.Judge JR. Giant condyloma acuminatum involving vulva and rectum. Arch Pathol 1969;88:46-8.  Back to cited text no. 5  [PUBMED]  
6.Knoblich R, Failing JF Jr. Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the rectum. Am J Clin Pathol 1967;48:389-95.  Back to cited text no. 6  [PUBMED]  
7.Lock MR, Katz DR, Samoorian S, Parks AG. Giant condyloma of the rectum: Report of a case. Dis Colon Rectum 1977;20:154-7.  Back to cited text no. 7  [PUBMED]  
8.Creasman C, Haas PA, Fox TA Jr, Balazs M. Malignant transformation of Anorectal Giant Condyloma Acuminatum (Buchke-loewenstein Tumor). Dis Colon Rectum 1989;32:481-7.  Back to cited text no. 8  [PUBMED]  


    Figures

  [Figure 1A], [Figure 1B], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
Previous article Next article

    

 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (85 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed4000    
    Printed185    
    Emailed0    
    PDF Downloaded173    
    Comments [Add]    

Recommend this journal