RECTAL PROLAPSE

• Rectal prolapse is circumferential descent of rectum through the anal canal.

 Types-

1. Rectal mucosal prolapse/ Partial prolapse-

• Protusion of the mucous membrane or the submucosa of the rectum outside the anal verge.

Etiology-

• In infants- undeveloped sacral curve.
• In children, habitual constipation, diarrhea, excessive straining, loss of fat.
• In females- due to torn perineum
• In males, straining from urethral obstruction.
• In old age- weakness of sphincter

Treatment-

• Digital reposition
• Injection of ethanolamine oleate into the submucosa of the rectum.
• Goodsall’s ligature- partial prolapsed is excised 

       2. Full thickness prolapsed-

• Also called as procidentia
• The protusionof all layers of rectal wall
• The prolapsed begins as an intussuception of the rectum which protrudes outside the anus.
• More common in females.
• It is often associated with prolapsed uterus.

Etiology-

• Weak anus, external sphincter & pelvic muscle
• Obliterated ano- rectal angle
• Excessive straining
• Deep rectovesical pouch

Clinical features-

• Constipation
• Excessive mucus discharge
• Tenesmus is also common
• Gives rise to urgency & perianal soiling
• Incontinence of faeces
• Procidentia
• Chronic dysentery, abdominal pain, and rectal prolapse in children is caused by Trichuris trichura.

 Investigations-

• Rectal examination- lax anal sphincter & wide gaping on straining
• Anal manometry
• Sigmoidoscopy

Treatment-

I) Perineal approach-

a) Treatment of rectal prolapse in childhood is Thiersch wiring

b) Delorme’s operation (reefing the rectal mucosa)

• Done in elderly patients
• Delorme’s operation is now preferred perineal operation.

c) Altemeier’s procedure-

• This consist of excision of prolapsed rectum and also sigmoid colon from below
• Urgency 7 incontinence are features. 

II) Abdominal procedure-

a) Well’s operation-

• Rectum is fixed firmly to the sacrum by inserting a sheet of polypropylene mesh between them.

b) Ripstein sling operation-

• Rectosigmoid junction is sutured to the sacrum by using Teflon sling

c) Mesh rectopexy-

1. Laproscopic mesh rectopexy method of fixing the mesh is the latest procedure of choice.

• Constipation is one of the complications of mesh rectopexy.

2. Mesh rectopexy with resection

3. Abdominal rectopexy (with or without sigmoid resection) offers the most durable repair, with recurrence occurring in fewer than 10% of patients for complete rectal prolapse