Giant Symptomatic Rectal Mucocele following Subtotal Colectomy

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pathology

Background:

• Rectal mucoceles are uncommon, typically arising post-colectomy due to persistent mucus production and anal stenosis.
• This case involves a 74-year-old female with a history of Crohn disease and subtotal colectomy.

Observation:

• The patient presented with a growing abdominal mass, indicating significant rectal and colonic dilatation.
• Endoscopic evaluation was impeded by severe anal and stomal site stenosis.
• Magnetic Resonance Imaging (MRI) revealed massive dilatation of the remaining colon and rectum.

Findings:

• A total proctocolectomy was performed, revealing a dilated rectum and sigmoid colon filled with calcified mucus.
• Pathology confirmed no evidence of dysplasia, malignancy, or active Crohn disease in the resected specimen.

Implications:

• This case underscores the critical need for endoscopic surveillance of the remaining rectum and colon in patients with inflammatory bowel disease and diverting stomas.
• When endoscopic access is impossible due to stenosis, surgical intervention should be considered to mitigate cancer risk.