Rectal Prolapse

Altmeir’s procedure involves excision of full thickness of the prolapsed rectum with part of sigmoid followed by anastomosis of remaining part of sigmoid to the anal canal from below and is hence a perineal procedure.

Ans. is ‘c’ i.e., Trichuris-trichiuria

Trichuris trichiura

.     Trichuris trichiura is an intestinal nematode, also known as whipworm.

.      Adult worms reside in the colon and cecum.

.     Other clinical manifestations are abdominal pain, anorexia, bloody diarrhea (dysentery) or mucoid diarrhea, rectal prolapse and growth retardation.

Trichinellosis

–        Most infections are asymptomatic.

–        Other clinical manifestations are :

.        Abdominal -4 Diarrhea or constipation, abdominal pain, nausea, vomiting.

.        Hypersensitivity reaction —> Fever with eosinophilia, periorbital and facial edema, hemorrhages in the subconjuctiva, retina and nail beds (splinter hemorrhages).

.       Rarely – Myocarditis with heart failure, encephalitis, pneumonitis.

.        Symptoms due to encystment of larva in muscles -4 Myositis with myalgia, weakness.

Ans is ‘c’ i.e. Abdominal rectopexy 

“Abdominal rectopexy (with or without sigmoid resection) offers the most durable repair, with recurrence occurring in fewer than 10% of patients.”-Schwartz 9/e p1054

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.

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.

Abdominal operations have three major approaches:

1. Reduction of the perineal hernia and closure of the cul-de-sac (Moschcowitz’s operation);
2. Fixation of the rectum, either with a prosthetic sling (Ripstein and Wells rectopexy) or by suture rectopexy. Rectopexy aims to secure the rectum to the sacral hollow. Abdominal rectopexy offers the most durable repair, with low recurrence.
3. Resection of redundant sigmoid colon

In some cases, resection is combined with rectal fixation (resection rectopexy). The addition of a sigmoid resection at the time of rectopexy lowers the recurrence rate and the incidence of postoperative constipation without increasing the morbidity.

Perineal approaches are:

1. Resecting the prolapsed bowel from the perineum (perinea] rectosigmoidectomy or Altemeier procedure)
2. Reefing the rectal mucosa (Delorme procedure), The Delorme procedure is mucosal proctectomy with plication of the prolapsing rectal wall. It is effective for patients with limited prolapse.
3. Tightening the anus with a variety of prosthetic materials (anal encirclement),

Anal encirclement procedures generally have been abandoned. Anal encirlement has limited application and is reserved by most surgeons for patients of the highest surgical risk or limited life expectancy because it can be done under local anesthesia. The original Thiersch procedure involved placing a silver wire around the external sphincter within the ishiorectal fat. Now synthetic mesh or silicone tubes are used instead of wire. The safety of current anesthetic techniques and the low morbidity and relative functional success of perineal proctectomy have made anal encirclement, for the most part, a procedure of the past.

Ans. is ‘c’ i.e., Thiersch’s operation 

Ans. is ‘a’ i.e., Rectal prolapse 

Rectal prolapse

Rectal prolapse often used to mean complete rectal prolapse (external rectal prolapse), where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body.However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on if the prolapsed section is visible externally, and if the full or only partial thickness of the rectal wall is involved

Rectal prolapse

Rectal prolapse often used to mean complete rectal prolapse (external rectal prolapse), where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on if the prolapsed section is visible externally, and if the full or only partial thickness of the rectal wall is involved.