Expected Color of Rectal Prolapse
A normal rectal prolapse should appear pink to red, similar to healthy rectal mucosa, and bright red color is indeed normal—however, any deviation toward dark red, purple, dusky, or gangrenous appearance signals vascular compromise requiring immediate surgical intervention. 1
Normal Appearance
- Healthy prolapsed rectal tissue is pink to red, reflecting viable mucosa with intact blood supply 2, 3
- The tissue should appear moist and glistening, consistent with normal rectal mucosa 4
- Bright red color indicates adequate perfusion and is the expected finding in uncomplicated rectal prolapse 5
Warning Signs of Strangulation
Visual inspection must immediately identify any color changes that indicate compromised blood supply:
- Gangrenous or necrotic tissue (dark, dusky, or black discoloration) indicates loss of blood supply and impending bowel death 1
- Purple or dusky appearance signals venous congestion and evolving ischemia 1
- The prolapsed segment becomes irreducible and edematous when strangulation develops 1
- Ulceration and perforation of the prolapsed mucosa can occur with prolonged strangulation 1
Critical Clinical Pitfall
Never assume bright red bleeding from prolapse is benign without proper evaluation:
- While bright red blood is typical of hemorrhoidal bleeding, rectal prolapse patients have a 4.2-fold increased risk of colorectal cancer (5.7% prevalence vs. 1.4% in controls) 6, 7
- Flexible sigmoidoscopy or colonoscopy should be routinely performed in all patients with symptomatic rectal prolapse 6
- Contrast-enhanced CT should be performed in complicated cases to rule out malignancy, obstruction, or perforation 6, 7
Immediate Management Based on Color
If the prolapse appears gangrenous, dusky, or shows signs of necrosis:
- Immediate surgical intervention is mandatory and must not be delayed for imaging in hemodynamically unstable patients 1
- Hemodynamic instability (hypotension, tachycardia, shock) signals advanced tissue necrosis with systemic compromise 1
- Elevated serum lactate and procalcitonin correlate with bowel ischemia and mortality risk 1
- An abdominal open approach is the recommended operative technique for unstable patients with complicated rectal prolapse 1
- Non-operative management is absolutely contraindicated when strangulation with gangrene or perforation is evident 1