| ID | 241 |
|---|---|
| Name | RECTAL PROLAPSE |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
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| Introduction | Rectal prolapse may be either partial- if only mucous membrane prolapse, or complete- if whole thickness of rectal wall prolapse. The condition is common in extremes of life. Partial prolapse is common in children. In adults prolapse is commonly complete. |
| History | |
| Etiology | Etiology: Partial prolapse: 1. In children the absence of sacral curve and malnutrition. Exciting causes are diarrhoea, constipation, whooping cough etc. 2. In adults, it may occur in association with 3rd degree hemorrhoids and following operation of fistula in ano. Complete prolapse: Following factors are important - 1. Abnormally deep recto-vaginal or recto-vesical pouch 2. Atony of anal sphincter and levator ani muscle 3. Loose fixation of rectum in sacral hollow. Partial prolapse- less than 4cm (l-4cm). Complete prolapse- more than 4cm (commonly 10-15cm). |
| Clinical Features | Clinical features: Symptoms: 1. Something coming out per anum during defecation or during walking. 2. Profuse discharge of mucus and occasional bleeding per anum, 3. Incontinence of feces and flatus. Signs: 1. Anus is patulous in complete prolapse. 3-4 fingers can be introduced into the rectum without any discomfort. 2. Prolapse may be obvious. |
| Preventions | |
| Treatment | Treatment: In children: It is usually a self-correcting disease. 1. Most cases respond to conservative measures of regular use of laxative and toilet training. The prolapse is reduced (digital repositioning). 2. Submucous injection of phenol in almond oil is used to produce adhesion between mucosa and muscle coat. 3. Submucous insertion of chromic catgut stich and narrowing of canal has been found to be effective. 4. Operation of rectosigmoidectomy may have to be performed in complete prolapse not responding to injection treatment. In adults: Partial prolapse- 1. Treatment by excision of the prolapsed mucosa as for the hemorrhoidec tomy. Before that injection phenol in submucosa may be tried. 2. Thiersch operation using silver wire or tefflon may be used especially in old and debilitated. Complete prolapse- 1. Thiersch operation, Or Delorme’s operation. 2. Insertion of polyvinyl alcohol sponge is the procedure of choice now a days. Rectum is mobilised- polyvinyl alcohol sponge is fixed in the sacrum and wrapped round the rectum. 3. Rectosigmoidectomy- amputation of the prolapse. 4. Roscoe- Graham operation. 5. Laparoscopic rectopexy. |
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