Extreme Uterine and Rectal Prolapse in a 31-Year-Old Patient: A Case Report

Background: Pelvic organ prolapse (POP) is a common disorder among postmenopausal women but is rare in very young patients. It can affect various compartments of the pelvic floor. In severe forms, vaginal/uterine and rectal prolapse can occur concurrently. Methods: The aim of this report is to present a rare case of a young patient with an extreme postpartum uterine and rectal prolapse and our stepwise surgical approach to achieve complete repair while preserving the ability to carry future pregnancies. Results: A 31-year-old patient was admitted with extreme postpartum uterine and rectal prolapse. She underwent three separate surgeries to regain full anatomic reconstruction. Initially, laparoscopic lateral suspension (LLS) according to Dubuisson's technique was performed in 2017. A combined vaginal-laparoscopic repair followed again in 2017 and included extensive posterior vaginal and perineal repair with absorbable mesh (SeraSynth) attached to the sacrouterine ligaments and laparoscopic hysterosacropexy (HySa) with a non-absorbable PVDF DynaMesh-CESA implant. Finally, in 2019, the DynaMesh-CESA implant was replaced with a T-shaped non-absorbable Albis Posterior Mesh for rectal prolapse, fixed bilaterally to the sacral bone at the S3 level. Additionally, the Dubuisson suspension was adjusted using Noé's pectopexy for the implant's reattachment to the pectineal ligaments. Conclusions: Severe uterine and rectal prolapse in young patients is rare and demands a tailored approach. Uterus-preserving surgery should be the priority. In the present case, a resorbable posterior mesh failed in rectal prolapse repair, while a combined rectal prolapse repair and hysteropexy with a non-resorbable posterior mesh proved effective.