Rectal Prolapse as a Rare Presentation of Colorectal Cancer: Case Series and Clinical Perspectives

Rectal prolapse is the protrusion of the rectum through the anal canal, commonly observed in older women with weakened pelvic floor muscles and anal sphincters. Clinical symptoms may include a painful, irreducible anal mass and rectal bleeding. Surgical intervention typically aims to restore normal anatomy through tumor resection and rectal fixation. The occurrence of colorectal cancer within rectal prolapse is rare and may present unique diagnostic and management challenges with distinct clinical implications.

We present three cases of rectal prolapse associated with colorectal cancer. The patients (aged 40, 79, and 79), one female and two males presented with rectal prolapse. One patient was seen in the outpatient clinic, while the other two presented to the emergency department with painful, strangulated prolapse. All patients underwent tailored surgical resections. Histological analysis revealed adenocarcinomas ranging from pT1 to pT2, all with N0Mx staging, two located in the rectum and one in the descending colon. These cases highlight the importance of preoperative imaging in identifying occult malignancies, particularly in atypical presentations of rectal prolapse.

Patients presenting with rectal prolapse, especially without predisposing factors, should be evaluated for underlying malignancy. Preoperative assessment is critical for identifying concomitant tumors and optimizing management to prevent recurrence and complications.