Rectal Prolapse Flashcards
What is rectal prolapse?
Descend of the rectal wall through the lower rectum &/or anal canal to protrude outside the anus
What are the types of rectal prolapse?
INTERNAL RP -> occult
EXTERNAL RP
- partial rectal prolapse
- complete rectal prolapse
What is the difference between partial & complete rectal prolapse?
PARTIAL COMPLETE
- mucosa only - whole thickness of rectal wall
- thin - thick
- < 5cm - > 5cm
CAUSED BY
- loss of weight - prolonged straining
- prolonged straining - abnormal fixation of rectum
- defect of anal sphincter
- advanced hemorrhoids
What will internal rectal prolapse lead to?
invagination of the proximal rectal wall inside the distal segment without protrusion from the anus -> obstructed defecation
What is the clinical picture of rectal prolapse?
- mass protruding from anus -> increase with straining
- mucous discharge
- obstructed defecation
- picture of complications
What are the complications of rectal prolapse?
- irreducibility
- strangulation
- ulceration
- bleeding
- faecal incontinence
What investigations are used to diagnose rectal prolapse?
- anorectal manometry
- defecography
- sigmoidscopy -> exclude any pathology or tumor
How should partial rectal prolapse be treated?
- treat THE CAUSE
- digital reposition in children
- submucous injection of the alcohol to induce fibrosis
- THEIRSCH OPERATION: peri-anal circlage
- GOODSALL operation: excision of excess mucosa
If severe & recurrent treat as complete RP
What is the standard operation in complete rectal prolapse?
POSTERIOR RECTOPEXY
- fixation of posterior rectal wall to sacral promontory
When is resectional rectopexy done?
In complete rectal prolapse involving long sigmoid
- sigmoidectomy “redundant colon” with posterior rectopexy
When is Altemier’s operation done?
Gangrenous rectum
- resection of the whole thickness of the prolapsed rectum, then reanastomosis
What is ventral rectopexy?
Fixation of the anterior rectal wall to the SACRAL promontory
What is Delorme’s operation?
Resection of the prolapse excess mucosa, then suturing with plication of the underlying submucosa
