Pediatric Rectal Prolapse Clinical Presentation

  • Author: Jaime Shalkow, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Dec 7, 2011
 

History

Parents usually observe rectal prolapse as a red ring of mucosa protruding from the rectum after the child defecates (see the image below). This finding is often associated with tenesmus and mucus or blood-stained clothing. Constipation is present in 25%-50% of individuals; as many as 75% present with fecal incontinence.

Photograph of severe rectal prolapse with clinicalPhotograph of severe rectal prolapse with clinically significant edema and mucosal ulceration.

Initially, the prolapse occurs with defecation and straining. As the pelvic floor musculature becomes more lax, the rectum may prolapse with the mildest straining, an upright position, or even spontaneously at rest. Most prolapses spontaneously reduce; however, the parents (or patient) occasionally have to manually reduce the prolapsed bowel.

A history of neonatal stooling problems or a family history of cystic fibrosis should be elucidated. The clinician should ask about excessive straining due to constipation or diarrhea (most common); prolonged sitting on a child’s “potty,” with hips and knees flexed; and previous operative correction of an imperforate anus. In addition, it should be determined whether there is a known history of any of the following:

  • Ehlers-Danlos syndrome
  • Hirschsprung disease
  • Congenital megacolon
  • Polyps
  • Pneumonia
  • Pertussis
  • Malnutrition/anorexia
  • Meningomyelocele
  • Parasitic infection
  • Rectal neoplasm

Frequently, patients with rectal prolapse also have associated dysfunction. More than 50% of patients present fecal incontinence. Fifteen to 65% of patients have constipation, with which excessive pushing during defecation induces mucosal injury of the anterior rectal wall, so the patient may also present with a solitary rectal ulcer.[27]

Next

Physical Examination

Most frequently, the patient presents with normal findings upon physical examination. Parents often provide history of a dark or bright-red mass protruding from the child’s anus, although the child appears to be pain free or in minimal discomfort.

Because most prolapses spontaneously reduce before arrival for evaluation, a brief examination of the patient in a sitting or squatting position and observation for recurrence of prolapse is recommended. (Other positions, such as jackknife or left lateral decubitus are frequently inadequate to reproduce the prolapse.)

Upon examination, the typical prolapsed rectum is a pouting, swollen rosette. In the case of a false or mucosal prolapse, the prolapsed tissue has radial folds at the anal junction, whereas a full-thickness prolapse has circular folds in the prolapsed mucosa (see the images below). If the rectum is prolapsed at the time of examination, palpation of the prolapsed mucosa between finger and thumb allows the examiner to distinguish between mucosal and full-thickness rectal prolapse.

Image demonstrates mucosal prolapse, with radial fImage demonstrates mucosal prolapse, with radial folds seen on mucosa. Diagram depicting clinical difference between trueDiagram depicting clinical difference between true (full-thickness) prolapse (left), including all layers of rectum and with circular folds seen on prolapsed intestine, and procidentia, or mucosa-only prolapse (right), in which radial folds are seen in mucosa.

If a mass is found at the time of examination, differentiate it from a prolapsing rectal polyp, which appears plum-colored and does not involve the entire anal circumference.

Consider intussusception. Findings upon a digital examination of the anus and rectum can differentiate prolapse of an intussusception from rectal prolapse. If an intussusception prolapses, a finger can be passed into a space between the anal wall and the mucosa of the protruding mass. With rectal prolapse, inserting a finger into this space is not possible.

Previous
Next

Complications

Complications of rectal prolapse include the following:

  • Incarceration - This refers to the entrapment of the prolapsed intestine, making it irreducible; it predisposes the patient to strangulation of the prolapsed segment
  • Strangulation and gangrene - When rectal prolapse cannot be reduced in a timely fashion, the resulting edema further precludes its reduction, to the point where the viability of the prolapsed segment is endangered; this condition is treated with emergency resection
  • Ulceration and hemorrhage - Trauma over the exposed mucosa produces ulcerations, bleeding, and mucous discharge in approximately 12% of patients; treatment involves correction of straining and defecation habits
  • Prolapse rupture - Excoriation of the mucosa can perforate the prolapsed intestine; urgent surgery is indicated for this complication
  • Incontinence - Incontinence should be observed for a period of 6-12 months because it is likely to spontaneously resolve
  • Cancer risk - No clear correlation between colorectal tumors and rectal prolapse has been established; however, a study in adults demonstrated a 4.2-fold increase in the relative risk for rectal cancer in patients with rectal prolapse[28]
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Jaime Shalkow, MD  Head of Surgical Oncology, Division of Surgery, National Institute of Pediatrics, Mexico; Head-Professor of Pediatric Surgical Oncology, Universidad Nacional Autonoma de Mexico

Jaime Shalkow, MD is a member of the following medical societies: American College of Surgeons, International Society of Pediatric Surgical Oncology, Mexican Association of Pediatric Surgery, Mexican Association of Pediatrics, Mexican Society of Oncology, and Pacific Association of Pediatric Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Brian F Gilchrist, MD  Surgeon-in-Chief of Pediatric Surgery, The Floating Hospital for Children at Tufts-New England Medical Center; Associate Professor, Department of Surgery, Tufts University School of Medicine

Brian F Gilchrist, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, and Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Jose Ignacio Guzman, MD  Medical Staff, Medical and Surgical Patient Care, General Hospital of Mexico; Medical Staff, Pediatric Surgical Oncology, National Institute of Pediatrics, Mexico

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Additional Contributors

Robert Baldassano, MD Director, Center for Pediatric Inflammatory Bowel Disease, Children's Hospital of Philadelphia; Professor, Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Pennsylvania School of Medicine

Robert Baldassano, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Deborah F Billmire, MD Associate Professor, Department of Surgery, Indiana University Medical Center

Deborah F Billmire, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Phi Beta Kappa, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Rebeccah Brown, MD Associate Director of Trauma Services, Associate Professor, Department of Clinical Surgery and Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati Hospital

Rebeccah Brown, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and American Medical Women's Association

Disclosure: Nothing to disclose.

Frank Cunningham, Jr, MD, FAAP, FACEP Director, Division of Emergency Pediatrics, Assistant Professor, Department of Pediatrics, University of Medicine and Dentistry of New Jersey

Frank Cunningham, Jr, MD, FAAP, FACEP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Joel A Friedlander, DO, MBe Instructor, Department of Pediatrics, University of Pennsylvania School of Medicine; Fellow, Pediatric Gastroenterology, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia

Joel A Friedlander, DO, MBe is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American College of Osteopathic Pediatricians, American Gastroenterological Association, American Medical Association, American Osteopathic Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Leon M Garner, DO, MPH Staff Physician, Department of Emergency Medicine, North Broward Medical Center

Leon M Garner, DO, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American College of Osteopathic Emergency Physicians

Disclosure: Nothing to disclose.

Harsh Grewal, MD, FACS, FAAP Professor of Surgery and Pediatrics, Temple University School of Medicine; Chief, Section of Pediatric Surgery, Temple University School of Medicine

Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Children's Oncology Group, Eastern Association for the Surgery of Trauma, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, and SouthwesternSurgical Congress

Disclosure: Nothing to disclose.

Marc S Lessin, MD Consulting Surgeon, Children's Surgical Associates, PC

Marc S Lessin, MD is a member of the following medical societies: American College of Surgeons and American Pediatric Surgical Association

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Maria Rebello Mascarenhas, MBBS Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief of Nutrition, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia

Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Lockhart-Mummery JP. Surgical procedures in general practice. Br Med J. 1939;1:345-7.

  2. Williams JG, Rothenberger DA, Madoff RD, Goldberg SM. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum. Sep 1992;35(9):830-4. [Medline].

  3. Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen years' experience with the one-stage perineal repair of rectal prolapse. Ann Surg. Jun 1971;173(6):993-1006. [Medline]. [Full Text].

  4. PORTER NH. A physiological study of the pelvic floor in rectal prolapse. Ann R Coll Surg Engl. Dec 1962;31:379-404. [Medline]. [Full Text].

  5. Mann CV. Rectal prolapse. In: Morson BC, Heinemann W, eds. Diseases of the Colon, Rectum and Anus. London: Medical Books; 1969:238.

  6. Hinninghofen H, Enck P. Fecal incontinence: evaluation and treatment. Gastroenterol Clin North Am. Jun 2003;32(2):685-706. [Medline].

  7. Katz C, Drongowski RA, Coran AG. Long-term management of chronic constipation in children. J Pediatr Surg. Oct 1987;22(10):976-8. [Medline].

  8. Van Heest R, Jones S, Giacomantonio M. Rectal prolapse in autistic children. J Pediatr Surg. Apr 2004;39(4):643-4. [Medline].

  9. Pearl RH, Ein SH, Churchill B. Posterior sagittal anorectoplasty for pediatric recurrent rectal prolapse. J Pediatr Surg. Oct 1989;24(10):1100-2. [Medline].

  10. Ponge T, Bruley des Varannes S. [Digestive involvement of scleroderma]. Rev Prat. Nov 1 2002;52(17):1896-900. [Medline].

  11. Candela G, Grillo M, Campione M, Casaburi V, Maschio A, Sciano D, et al. [Complete rectal prolapse in a patient with Hirschsprung disease: a clinical case]. G Chir. Aug-Sep 2003;24(8-9):289-94. [Medline].

  12. Sanaka MR, Ferguson DR, Ulrich S, Sargent R. Polyp associated with rectal prolapse. Gastrointest Endosc. Jun 2004;59(7):871-2. [Medline].

  13. Orenstein DM, Winnie GB, Altman H. Cystic fibrosis: a 2002 update. J Pediatr. Feb 2002;140(2):156-64. [Medline].

  14. Villareal M, Blum P. Prolapso rectal en un recien nacido con diarrea por Shigella. Arch Argent Pediatr. 2010;108(1):e17-e19.

  15. Rock MJ. Newborn screening for cystic fibrosis. Clin Chest Med. Jun 2007;28(2):297-305. [Medline].

  16. Rittmeyer C, Nakayama D, Ulshen MH. Lymphoid hyperplasia causing recurrent rectal prolapse. J Pediatr. Sep 1997;131(3):487-8. [Medline].

  17. Huskins WC, Griffiths JK, Faruque AS, Bennish ML. Shigellosis in neonates and young infants. J Pediatr. Jul 1994;125(1):14-22. [Medline].

  18. Hussein AM, Helal SF. Schistosomal pelvic floor myopathy contributes to the pathogenesis of rectal prolapse in young males. Dis Colon Rectum. May 2000;43(5):644-9. [Medline].

  19. Carrada-Bravo T. [Massive childhood trichocephaliasis]. Rev Gastroenterol Mex. Jul-Sep 2002;67(3):212. [Medline].

  20. Pancharoen C, Likitnukul S, Chongsrisawat V, Vivatvekin B, Bhattarakosol P, Suwangool P, et al. Rectal prolapse associated with cytomegalovirus pseudomembranous colitis in a child infected by human immunodeficiency virus. Southeast Asian J Trop Med Public Health. Sep 2003;34(3):583-4. [Medline].

  21. Adedayo O, Nasiiro R. Intestinal parasitoses. J Natl Med Assoc. Jan 2004;96(1):93-6. [Medline]. [Full Text].

  22. Bush A. Recurrent respiratory infections. Pediatr Clin North Am. Feb 2009;56(1):67-100, x. [Medline].

  23. Brodén B, Snellman B. Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum. Sep-Oct 1968;11(5):330-47. [Medline].

  24. Corman ML. Rectal prolapse in children. Dis Colon Rectum. Jul 1985;28(7):535-9. [Medline].

  25. Nwako F. Rectal Prolapse in Nigerian Children. Int Surg. May 1975;60(5):284-5. [Medline].

  26. Hight DW, Hertzler JH, Philippart AI, Benson CD. Linear cauterization for the treatment of rectal prolapse in infants and children. Surg Gynecol Obstet. Mar 1982;154(3):400-2. [Medline].

  27. Yoon SG. Rectal prolapse: review according to the personal experience. J Korean Soc Coloproctol. Jun 2011;27(3):107-13. [Medline]. [Full Text].

  28. Rashid Z, Basson MD. Association of rectal prolapse with colorectal cancer. Surgery. Jan 1996;119(1):51-5. [Medline].

  29. Godbole P, Botterill I, Newell SJ, Sagar PM, Stringer MD. Solitary rectal ulcer syndrome in children. J R Coll Surg Edinb. Dec 2000;45(6):411-4. [Medline].

  30. Wijffels NA, Collinson R, Cunningham C, Lindsey I. What is the natural history of internal rectal prolapse?. Colorectal Dis. Aug 2010;12(8):822-30. [Medline].

  31. Festen S, van Geloven AA, D'Hoore A, Lindsey I, Gerhards MF. Controversy in the treatment of symptomatic internal rectal prolapse: suspension or resection?. Surg Endosc. Jun 2011;25(6):2000-3. [Medline]. [Full Text].

  32. Savoye-Collet C, Koning E, Dacher JN. Radiologic evaluation of pelvic floor disorders. Gastroenterol Clin North Am. Sep 2008;37(3):553-67, viii. [Medline].

  33. Ashcraft KW, Garred JL, Holder TM, Amoury RA, Sharp RJ, Murphy JP. Rectal prolapse: 17-year experience with the posterior repair and suspension. J Pediatr Surg. Sep 1990;25(9):992-4; discussion 994-5. [Medline].

  34. Felt-Bersma RJ, Tiersma ES, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele. Gastroenterol Clin North Am. Sep 2008;37(3):645-68, ix. [Medline].

  35. Norton C. Fecal incontinence and biofeedback therapy. Gastroenterol Clin North Am. Sep 2008;37(3):587-604, viii. [Medline].

  36. Antao B, Bradley V, Roberts JP, Shawis R. Management of rectal prolapse in children. Dis Colon Rectum. Aug 2005;48(8):1620-5. [Medline].

  37. Ramanujam PS, Venkatesh KS. Management of acute incarcerated rectal prolapse. Dis Colon Rectum. Dec 1992;35(12):1154-6. [Medline].

  38. Coburn WM 3rd, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med. Sep 1997;30(3):347-9. [Medline].

  39. Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. Oct 8 2008;CD001758. [Medline].

  40. Brown AJ, Anderson JH, McKee RF, Finlay IG. Strategy for selection of type of operation for rectal prolapse based on clinical criteria. Dis Colon Rectum. Jan 2004;47(1):103-7. [Medline].

  41. RIPSTEIN CB, LANTER B. Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg. Feb 1963;157:259-64. [Medline]. [Full Text].

  42. Abes M, Sarihan H. Injection sclerotherapy of rectal prolapse in children with 15 percent saline solution. Eur J Pediatr Surg. Apr 2004;14(2):100-2. [Medline].

  43. Chan WK, Kay SM, Laberge JM, Gallucci JG, Bensoussan AL, Yazbeck S. Injection sclerotherapy in the treatment of rectal prolapse in infants and children. J Pediatr Surg. Feb 1998;33(2):255-8. [Medline].

  44. Dattani PG. 15th International Conference on AIDS. 15. Bangkok, Thailand: Jul, 2004:abstract no. B11748.

  45. Ibáñez V, Gutiérrez C, García-Sala C, Lluna J, Barrios JE, Roca A, et al. [The prolapse of the rectum. Treatment with fibrin adhesive]. Cir Pediatr. Jan 1997;10(1):21-4. [Medline].

  46. Fahmy MA, Ezzelarab S. Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children. Pediatr Surg Int. May 2004;20(5):353-6. [Medline].

  47. Zganjer M, Cizmic A, Cigit I, et a;. Treatment of rectal prolapse in children with cow milk injection sclerotherapy: 30-year experience. World J Gastroenterol. Feb 7 2008;14(5):737-40. [Medline]. [Full Text].

  48. Lomas MI, Cooperman H. Correction of rectal procidentia by use of polypropylene mesh (Marlex). Dis Colon Rectum. Nov-Dec 1972;15(6):416-9. [Medline].

  49. Saleem MM, Al-Momani H. Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child. BMC Surg. Dec 28 2006;6:19. [Medline]. [Full Text].

  50. El-Sibai O, Shafik AA. Cauterization-plication operation in the treatment of complete rectal prolapse. Tech Coloproctol. Apr 2002;6(1):51-4; discussion 54. [Medline].

  51. Sander S, Vural O, Unal M. Management of rectal prolapse in children: Ekehorn's rectosacropexy. Pediatr Surg Int. 1999;15(2):111-4. [Medline].

  52. Schepens MA, Verhelst AA. Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children. J Pediatr Surg. Nov 1993;28(11):1494-7. [Medline].

  53. Joshi AA, Milanovic DM. Delorme's procedure for rectal prolapse in a child refractory to conservative treatment and rectal suspension. Int J Colorectal Dis. 2006;21:395-6.

  54. Lieberth M, Kondylis LA, Reilly JC, Kondylis PD. The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg. Mar 2009;197(3):418-23. [Medline].

  55. Lee JI, Vogel AM, Suchar AM, Glynn L, Statter MB, Liu DC. Sequential linear stapling technique for perineal resection of intractable pediatric rectal prolapse. Am Surg. Dec 2006;72(12):1212-5. [Medline].

  56. Yamana T, Iwadare J. Mucosal plication (Gant-Miwa procedure) with anal encircling for rectal prolapse--a review of the Japanese experience. Dis Colon Rectum. Oct 2003;46(10 Suppl):S94-9. [Medline].

  57. Lasheen AE. Closed rectosacropexy for rectal prolapse in children. Surg Today. 2003;33(8):642-4. [Medline].

  58. Kairaluoma MV, Viljakka MT, Kellokumpu IH. Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome. Dis Colon Rectum. Mar 2003;46(3):353-60. [Medline].

  59. Delaney CP. Laparoscopic management of rectal prolapse. J Gastrointest Surg. Feb 2007;11(2):150-2. [Medline].

  60. Koivusalo A, Pakarinen M, Rintala R. Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: a preliminary report. Surg Endosc. Jun 2006;20(6):960-3. [Medline].

  61. Senagore AJ. Management of rectal prolapse: the role of laparoscopic approaches. Semin Laparosc Surg. Dec 2003;10(4):197-202. [Medline].

  62. D'Hoore A, Penninckx F. Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. Dec 2006;20(12):1919-23. [Medline].

  63. Saxena AK, Metzelder ML, Willital GH. Laparoscopic suture rectopexy for rectal prolapse in a 22-month-old child. Surg Laparosc Endosc Percutan Tech. Feb 2004;14(1):33-4. [Medline].

  64. Shin T, Rafferty JF. Laparoscopy for benign colorectal diseases. Clin Colon Rectal Surg. Feb 2010;23(1):42-50. [Medline]. [Full Text].

  65. Gupta PJ. Treatment of rectal prolapse with radiofrequency ablation and plication--a new surgical technique. Acta Chir Belg. Sep-Oct 2007;107(5):535-9. [Medline].

  66. Nyström PO, Qvist N, Raahave D, Lindsey I, Mortensen N. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. Br J Surg. Feb 2010;97(2):167-76. [Medline].

  67. Zhang M. Thirty-six cases of infantile proctoptosis treated by extremely shallow puncture. J Tradit Chin Med. Mar 2002;22(1):33-4. [Medline].

  68. Flum AS, Golladay ES, Teitelbaum DH. Recurrent rectal prolapse following primary surgical treatment. Pediatr Surg Int. Apr 2010;26(4):427-31. [Medline]. [Full Text].

 
Previous
Next
 
Image of young patient with full-thickness rectal prolapse with multiple circular folds seen on exposed mucosa.
Photograph of severe rectal prolapse with clinically significant edema and mucosal ulceration.
Picture of infant with full-thickness rectal prolapse. Severe edema and abundant mucus are seen on mucosal surface.
Levator ani muscle is shown in red. It includes ileococcygeus (stretches during defecation and labor), pubococcygeus (maintains integrity of pelvic floor), and puborectalis (closes anorectal canal as sling) muscles.
Deep, superficial, and subcutaneous external sphincter.
Anatomy of internal and external anal sphincter mechanisms.
Image demonstrates mucosal prolapse, with radial folds seen on mucosa.
Diagram depicting clinical difference between true (full-thickness) prolapse (left), including all layers of rectum and with circular folds seen on prolapsed intestine, and procidentia, or mucosa-only prolapse (right), in which radial folds are seen in mucosa.
Thiersch procedure. Perianal subcutaneous sutures create mechanical barrier for prolapse.
Lomas and Cooperman modified Thiersch procedure by performing right anterior and left posterior radial incisions, encircling anus with Marlex mesh stripe, and tying it around finger placed on anal canal. Care must be taken to avoid perforating posterior vaginal wall or anterior rectal wall. Skin is closed, with mesh left subcutaneously.
Ripstein procedure is designed to maintain normal posterior rectal curvature by attaching it to presacral fascia, thus avoiding straight tube that intussuscepts during straining. (A) Rectum is mobilized down to coccyx. (B) Marlex mesh is placed around rectum while this is tensed upward and sutured to presacral fascia with nonabsorbable material. Mesh loop must be loose enough to prevent postoperative constipation. (C) Sagittal view shows suspended rectum. (D) Peritoneum is closed with a continuous absorbable suture.
Intraoperative photograph of 12-year-old girl with recurrent rectal prolapse and mucosal ulceration with profuse bleeding. She had long sigmoid colon, which was resected; end-to-end anastomosis was performed. This photograph depicts anastomosed rectum fixed to presacral fascia with mesh. Nonabsorbable sutures retain mesh to serosa. Note that mesh is slightly loose to allow for child's growth. Uterus and its ligaments can be seen in front of rectum. Iliac vessels remain intact on each side.
Ivalon sponge procedure. (A) Rectum is mobilized. Meticulous hemostasis is mandatory to prevent hematoma that predisposes patient to prosthetic material infection. (B) Ivalon rectangular sponge made of polyvinyl alcohol is sutured to sacral periosteum. (C) Rectum is retracted upward, and sponge is wrapped around it and tied to anterior surface. Portion of anterior rectal wall is left free to prevent luminal obliteration. (D) Peritoneum is closed with continuous absorbable suture.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.