AccScience Publishing / STI / Volume 46 / Issue 1 / DOI: 10.36922/STI026070010
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RESEARCH ARTICLE

Rectal Prolapse: A Morphological Analysis of the Rectal Wall

Aldo Bove1†* ,  Matteo Costanzi1†§ ,  Gianmarco Stati2 ,  Gino Palone1 ,  Eleonora Conte1 ,  Valentina Giansante2 ,  Luca Morello2 ,  Roberto Manunzio1 ,  Roberta Di Pietro2
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1 Department of Medicine, Dentistry and Biotechnology, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
2 Department of Medicine and Aging Sciences, Section of Biomorphology, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
†These authors contributed equally to this work.
STI 2026, 46(1), 026070010 https://doi.org/10.36922/STI026070010
Received: 12 February 2026 | Revised: 18 April 2026 | Accepted: 12 May 2026 | Published online: 5 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: The etiopathogenetic mechanism of recto-anal prolapse disease with obstructed defecation syndrome (ODS) remains unclear. According to the diag­nostic-instrumental approach, the pathology is described as the outcome of a mechani­cal phenomenon, but studies using a histomorphological approach remain meager. This study aims to identify structural and morphological features of the rectal wall to clarify the etiopathogenetic causes of the disease and to hypothesize new therapeutic indica­tions.

Methods: This is a morphological, prospective observational study. A morphological and morphometric analysis of rectal wall incisional biopsies was performed. The spec­imens were collected from 20 patients with rectal-anal prolapse grade III/IV and ODS after the stapled trans-anal rectal resection (STARR) surgical technique.

Results: Histochemical staining of pathological samples confirmed the inflammation of the mucosal layer, detection of histiocytes with foamy cytoplasm with likely mucinous or lipid content, fibrosis of the submucosa, loss of structural integrity, and thickening of the muscularis mucosae (Welch’s t-test: p = 2.8459 × 10−7). There was no significant differ­ence in the mucosal layer thickness compared to controls (Welch’s t-test: p = 0.2689).

Conclusion: Patients with rectal prolapse and ODS present inflammation of the rectal wall, and the muscularis mucosae shows a loss of mucosal layer consistency, consistent with the genesis of mucosal prolapse. Evidence of our histomorphological features could support the unitary theory of rectal prolapse. The correlation between these frameworks and clinical symptoms should be validated in a larger study.

Keywords
Etiopathogenetic mechanism
Histochemical staining
Morphological Features
Rectal prolapse
Stapled trans-anal rectal resection surgical technique (STARR)
Funding
This research received no external funding.
Conflict of interest
The authors declare no conflicts of interest.
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Surgical Technology International, Electronic ISSN: 1090-3941 Published by AccScience Publishing
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