Download Rectal Prolapse Notes and more Study Guides, Projects, Research Medical Sciences in PDF only on Docsity! Rectal Prolapse
* Definition : Protrusion of the rectum through the anus .
* Types : There are 2 types of rectal prolapsed
1) Partial rectal prolapse :is prolapsed of mucosa only .
2) Complete rectal prolapse :is prolapsed of whole thickness of
rectal wall.
* Incidence : Partial rectal prolapse is common in children while
complete rectal prolapse is more in adult and elderly females .
* Aetiology :
Children Adult & Elderly
= Loss of normal curve of = Weakness of pelvic floor muscles due to
sacrum. repeated delivery .
= Loss of weight ā loss of = In Egypt the commonest cause is
supporting pararectal & bilharzial ulcers and polyps > continuous
ischeorectal fat . tenesmus & straining
= Chronic straining e.g. chronic | = Chronic diarrhoea and tenesmus .
constipation , diarrhoea with * Chronic straining e.g. BPH
tenesmus or whooping cough . " Sliding hernia with deep rectovesical or
rectovaginal pouch .
Ā« Intussusception start 10 cm from anal
verge.
Circular muscle Mucosa
Rectal Prolapse
Rectal Prolapse
* Treatment :
I) Children :
" The condition usually resolve spontaneously with progress of
age therefore treatment is mainly conservative .
= Treatment of constipation , diarrhoea , tenesmus .
= Improve nutrition of the patient
= Manual reduction by the mother after defecation followed by
strapping the buttoks to prevent prolapsed .
Ā« In resistant cases , submucous injection of 5% phenol in
almond oil .
II) Adults :
a) Partial rectal prolapse :
1- Early small prolapse: submucous injection of 5% phenol
in almond oil
2- Large prolapse: excision of the prolapsed mucosa .
b) Complete rectal prolapsed :
1) Rectopexy :
= Through abdominal approach (usually laparoscopic or
rarely open open open) the rectum is pulled upwards.
= A polypropylene mesh is sutured to presacral fascia and
around the side and back of rectum .
Ā« Fibrous tissue initiated by the mesh fixes the rectum in its
high new position .
2)Sigmoid resection and rectopexy .
3)Delormeās operation :
= Through trans-anal approach , the excess rectal mucosa
above the dentate line is excised .
Rectal Prolapse
= Sutures are used to approximate the edges of the
mucosa and pass through rectal muscles , placating them
4)Narrowing of the anus :
= The prolapsed is reduced and a stainless steel wire is
tunnelled subcutaneously around the anus .
= The suture is tied snugly around the the finger of the
surgeon
Rectopexy
āSource: Kaiser AM: McGraw-Hill Manual Colorectal Surgery:
Delormeās procedure
A B c
Plicated
muscle
layers
Rectal Prolapse
Narrowing of the
