Pediatric Rectal Prolapse Workup

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

Approach Considerations

The primary care physician should initially approach rectal prolapse as a symptom rather than a specific disease entity and should always search for an underlying disorder. Anatomic causes, such as Hirschsprung disease and previous imperforate anus, should be ruled out. Constipation, diarrhea, parasitic infections, polyps, and anal stenosis.

In particular, cystic fibrosis is an important cause of rectal prolapse in children and should be considered in certain patients who present with rectal prolapse. Clinical clues to cystic fibrosis include oily, malodorous, or floating stool; poor growth pattern; wheezing or other respiratory symptoms; and the presence of digital clubbing. The absence of respiratory symptoms and normal findings upon physical examination do not exclude this possibility. Results of sweat chloride testing and genetic testing confirm the diagnosis.

Over the past decade, there have been considerable advances in several imaging techniques. High-resolution ultrasonography and magnetic resonance imaging (MRI) not only provide superior depiction of the pelvic anatomy but also help to illustrate pathology and document functional changes. Barium enema, proctosigmoidoscopy, video defecography, anal manometry, electromyography, and anal endosonography may be useful.

Internal rectal prolapse (IRP) refers to a full-thickness intussusception of the rectum during defecation. Radiographically, different grades have been proposed, from low-grade (recto-rectal intussusception) to high-grade (rectoanal intussusception) rectal prolapse. This kind of prolapse may lead to outlet obstruction and/or fecal incontinence. IRP plays an important role in the pathophysiology of obstructive defecation (OD), which refers to the inability to empty the rectum satisfactorily during defecation, and is more specifically defined in the Rome III criteria.

For decades, there has been debate about the clinical significance of IRP. However, there appears to be a renewed interest in the clinical relevance and treatment of IRP. The long-disputed progression into external rectal prolapse (ERP) has been made more plausible by data published by Wijffels et al.[30] on the natural history of IRP. Moreover, various other publications on new surgical techniques have shown improved functional outcome after prolapse correction compared with historical surgical series. Patient selection remains critical.

Surgical correction for IRP is possible via a transabdominal or transanal approach. Currently, the most commonly performed procedures are laparoscopic ventral rectopexy (LVR) and stapled transanal rectal resection (STARR). LVR corrects the intussusception of the rectum and reinforces the rectovaginal septum with mesh, which suspends the rectum and vaginal vault to the sacral promontory. During the STARR procedure, a stapled resection of the redundant rectal wall is performed. Most recent publications on IRP and OD are divided between proponents of these 2 techniques. There are, however, no comparative studies, making it difficult to select the optimal treatment for each individual patient.[31]

Next

Laboratory Tests

Sweat chloride test

Because of the potentially disastrous consequences of missing the diagnosis of cystic fibrosis and because of the improved prognosis associated with early diagnosis and institution of treatment, the sweat chloride test is indicated in all patients who present without an underlying anatomic abnormality.

Although cystic fibrosis is not a likely diagnosis in patients who present with rectal prolapse, the estimated incidence of rectal prolapse in patients with cystic fibrosis ranges from 11-23% (20% in patients with cystic fibrosis who are aged 6 months to 3 years). Accordingly, cystic fibrosis should be ruled out in patients who present with rectal prolapse, even if no other signs of the disease are present.

Stool evaluation for ova and parasites

Rectal prolapse has been associated with Escherichia coli 0157:H7; antibiotic-associated colitis; Entamoeba histolytica; and Giardia, Salmonella, Shigella, and Trichuris species. Consider workup for other associated illnesses in the appropriate setting as clinically indicated.

Previous
Next

Magnetic Resonance Imaging

MRI can be used both for a multicompartmental dynamic assessment of the pelvic floor—referred to as dynamic MRI defecography—and for the anatomic analysis of the internal anal sphincter (IAS) and the external anal sphincter (EAS)—referred to as static MRI. The enormous potential of MRI in this setting underscores the importance of the radiologist as part of the multidisciplinary team, a part that is needed for an integrated evaluation of pelvic floor disorders.[32]

Previous
Next

Barium Enema

Sigmoid intussusception rarely presents as rectal prolapse in pediatric patients. In 1990, Ashcraft et al highlighted the importance of preoperative diagnosis for prevention of inappropriate initial treatment and postoperative recurrence.[33] In their series of 46 patients, 2 required subsequent sigmoid resection. Preoperative barium enema with a defecating view revealed a coiled-spring appearance typical of sigmoid intussusception.

A contrast enema study may be needed to look for polyps or other leading points.

Previous
Next

Video Defecography

Video defecography (ie, videofluoroscopy of the barium-filled rectum during defecation) can be used to identify rectal prolapse or intussusception. This study can demonstrate prolapse through the anus, but it is unnecessary for full-thickness rectal prolapse. The anorectal angle is often obtuse in patients with rectal prolapse, especially in those with coexisting fecal incontinence.[34]

Previous
Next

Proctosigmoidoscopy

Children with symptoms that suggest rectal polyps should undergo proctosigmoidoscopy to confirm the diagnosis, to obtain biopsy samples when applicable, and to rule out a leading point in the case of intussusception.

Patients with recurring rectal prolapse with no apparent cause or a history of rectal bleeding should undergo proctosigmoidoscopy to rule out polyps.

Previous
Next

Other Tests

Anal manometry

The clinical and cost benefits of routine preoperative anal manometry, pudendal nerve motor latency, colonic transit, and defecography are unclear. Anal manometry shows low resting pressure; patients with coexisting fecal incontinence also have low squeezing pressures. However, after surgery, the resting pressure or sphincter length may not change or improve. Squeeze pressure may improve.[34]

Electromyography

Electromyography has provided insights into the pathogenesis of fecal incontinence; however, it has no place in the clinical workup for this entity, and hardly any research has been done so far. Abnormalities can be found in patients with a rectal prolapse, but these results do not predict continence after rectopexy.[34]

Anal endosonography

Anal endosonography may show asymmetry and thickening of the internal anal sphincter and submucosa. Demonstration of a sphincter defect might be useful if a sphincter reconstruction is being considered.[34]

Previous
Proceed to Treatment & Management
 
 
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.