Rectal Prolapse

INTRODUCTION:

  • Women > 50 yrs
  • Young men with h/o psychiatric disease, medications for constipation
  • In children, the prolapse is usually mucosal and treated conservatively
  • In adults, prolapse is often full thickness and associated with incontinence
  • Partial prolapse – only mucosa and submucosa descends not more than 3.75cm
  • Chronic dysentery, abdominal pain, and rectal prolapse in children is caused by Trichuris trichura
TREATMENT:
  • Treatment for partial prolapse
  • Submucosal injection of 5% phenol in almond oil or ethanolamine oleat
  • Goodsall's operation Treatment for complete prolapsed
  • Abdominal rectopexy (with or without sigmoid resection) offers the most durable repair, with recurrence occurring in fewer than 10% of patients for complete rectal prolapse There are 2 classes of operations for rectal prolapse: abdominal and perineal.
  • The choice of operation depends in part upon the patient's overall medical condition.
  • Treatment of rectal prolapse in childhood is Thiersch wiring
  • The abdominal procedures have a lower recurrence rate but carry more risk and thus are generally preferred in low-risk active patients.
  • The perineal approaches are preferred in high risk old age patients with comorbidities due to less perioperative morbidity and pain; but have a high recurrence rate.
  • Perineal approach :To avoid possible damage to pelvic autonomic nerves in abdominal approach which may result in sexual dysfunction, perineal approach is preferred in young men
  1. Also in elderly and very frail patients
  2. Delorme's operation [most preferred], Thiersch operation, Altemeier's procedure
  • Abdominal approach : For complete prolapse in patients with good health
  1. Well's operation
  2. Ripsteins operation [sling operation]
  3. Rectopexy e or tetracycline given into the apex of prolapse and supported by Thiersch wiring (temporary)
  4. Lahaul’s operation
Exam Question
  • Well’s operation,Lahaul’s operation,Ripstein’s sling operation are abdominal procedure for rectal prolapse
  • A young male patient presents with complete rectal prolapse. The surgery of choice is Abdominal Rectopexy
  • Chronic dysentery, abdominal pain, and rectal prolapse in children is caused by Trichuris trichura
  • Treatment of rectal prolapse in childhood is Thiersch wiring
  • Delorme's Procedure is used for Rectal prolapse
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