Dear Editor, Pelvic organ prolapse (POP) is an increasingly common problem as women are living longer. Based on a review of the literature, POP after multiple colorectal surgery was never been reported. In a recent study, 48% of patients treated for rectal prolapse developed genital prolapse at some point of time [1]. The combination of rectopexy and concomitant sigmoid resection (the “Frykman-Goldberg operation”) as done in this case is frequently used to decrease the risk for postoperative constipation problems. The risk of adhesions from previous laporotomy and other surgeries may contribute to some difficulty during surgery for POP especially during the dissection and also for sacrospinous ligament fixation (SSLF) to be done posteriorly.

We report on a case of anterior approach right SSLF for recurrent stage IV POP in a woman with previous laparotomy rectopexy with sigmoid resection. A case of a 74-year-old lady was referred to urogynaecological clinic with a chief complaint of protruding mass from the vagina, obstructive urinary symptom without intestinal symptoms of 3-month duration. She had four previous uncomplicated vaginal deliveries. Her diabetes mellitus and hypertension was well controlled with medication. A surgery for cloaca with anterior rectoanal sphincter defect was done 25 years ago. Rectocele and cystocele were also diagnosed in which anterior colporrhaphy and advanced anoplasty was performed by colorectal surgeon a year later by native tissue repair. Eleven years later, another three rectal surgeries were done on her. She had a haemorrhoidectomy done on 24th January 1999. Two months later, she had a complication of rectovaginal fistula and repair done on 26th March 1999. On 30th June 1999, she had a problem of rectal prolapse in which laparotomy with sigmoid resection and rectopexy was performed. Presently, her pelvic examination revealed that she had stage IV POP on ICS-POPQ staging (+ 2,+ 10,+ 9, 5, 1, 10,+ 1,+ 5,+ 7).