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Advanced Emergency Nursing JournalEvaluation and management of older adults within emergency care settings is often complex and has the potential for avoidable complications. In an effort to prevent harm...
Evaluation and management of older adults within emergency care settings is often complex and has the potential for avoidable complications. In an effort to prevent harm to the patient, treatment strategies need to be multifactorial. For geriatric patients presenting with rectal prolapse, unique management strategies, including the use of granulated sugar and gentle pressure, may assist in the reduction of the prolapsed tissue. Additional interventions that are important to incorporate into the older adult's plan of care include gentle approaches to positioning, involvement of family/caregivers, avoiding harmful medications, reducing risk for delirium, and a successful transition of care. A manual reduction completed in the emergency department can relieve discomfort and prevent further complications while the patient awaits surgical evaluation and intervention. Prompt evaluation and management by the advanced practice registered nurse may not only expedite recognition of the prolapse, but can reduce iatrogenic complications that may occur from delayed treatment.
Topics: Humans; Aged; Rectal Prolapse; Patients; Caregivers; Emergency Service, Hospital; Sugars
PubMed: 36269812
DOI: 10.1097/TME.0000000000000429 -
Journal of Pediatric Gastroenterology... Feb 2020Rectal prolapse is a protrusion of rectal mucosa through the anal sphincter. Although uncommon, it is seen more often in children, younger than 4 years of age. The last...
BACKGROUND
Rectal prolapse is a protrusion of rectal mucosa through the anal sphincter. Although uncommon, it is seen more often in children, younger than 4 years of age. The last data analysis of rectal prolapse and its clinical characteristics in children was performed over 30 years ago. Since that time, many medical advances have occurred that may alter our workup and management of this disease in children. We performed a chart review to reassess the clinical characteristics of rectal prolapse and its management.
METHODS
This was a retrospective descriptive analysis study, assessing children less than 18 years of age that were diagnosed with rectal prolapse from 1999 to 2014 at a single tertiary care center. The onset of presentation, demographics, etiology, clinical characteristics, and management were analyzed.
RESULTS
A total of 158 patients were diagnosed with rectal prolapse, with mean age of onset being 3 years. Constipation was the leading cause, with straining being the most common complaint. Stool consistencies with constipation varied. Many patients diagnosed with idiopathic recurrent rectal prolapse had either a social stressor or were described as having unusual behaviors associated with prolapse. Cystic fibrosis was only diagnosed in 4 patients. Thirty-four patients (22%) required surgical correction.
CONCLUSIONS
Constipation remains the main cause of rectal prolapse. Cystic fibrosis is no longer a common etiology for rectal prolapse, because of the implementation of newborn screening. Patients with social stressors or atypical behavior may be at risk for recurrent rectal prolapse.
Topics: Anal Canal; Child; Child, Preschool; Constipation; Humans; Infant, Newborn; Rectal Prolapse; Rectum; Retrospective Studies; Treatment Outcome
PubMed: 31978025
DOI: 10.1097/MPG.0000000000002546 -
International Journal of Colorectal... Dec 2016Internal rectal prolapse is common and correlates with age. It causes a plug-like physical obstruction and is a major cause of defecation disorder. The progressive...
PURPOSE
Internal rectal prolapse is common and correlates with age. It causes a plug-like physical obstruction and is a major cause of defecation disorder. The progressive distortion of the prolapsing rectum likely causes secondary defects in the rectal wall, which may exacerbate rectal dysfunction. We undertook a prospective observational study to detect and quantify the neurologic and histopathologic changes in the rectal wall.
METHODS
We examined dorsal and ventral rectal wall specimens from consecutive patients with internal rectal prolapse undergoing stapled transanal rectal resection (STARR). We subjected specimens to histopathologic and neuropathologic assessment, including immunohistochemistry. We also recorded patients' clinical and demographic characteristics and sought correlations between these and the pathologic findings.
RESULTS
We examined 100 specimens. The severity of rectal prolapse and the extent of descent of the perineum correlated significantly with age. Concomitant hemorrhoidal prolapse was noted in all male patients and in 79 % of female patients. Muscular and neuronal defects were detected in 94 and 90 % of the specimens, respectively. Only four specimens (4 %) were free of significant structural defects.
CONCLUSION
Rectal prolapse traumatizes the rectum causing neuromuscular defects. The tissue trauma is due to shearing forces and ischemia caused by the intussusception. This initiates a self-reinforcing vicious circle of physical and functional obstruction, further impairing rectal evacuation and causing constipation and incontinence. The correlation between extent of prolapse and age suggests that internal rectal prolapse can be considered a degenerative disorder. Neural and motor defects in the wall of the rectum caused by rectal prolapse are likely irreversible.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Defecography; Female; Humans; Male; Middle Aged; Neuromuscular Junction; Rectal Prolapse; Rectum
PubMed: 27599704
DOI: 10.1007/s00384-016-2649-8 -
Journal of Visceral Surgery Apr 2015There is now sufficient data in the literature to compare pedicular hemorroidectomy (Milligan and Morgan, Ferguson), the reference operation, to the Longo procedure... (Review)
Review
There is now sufficient data in the literature to compare pedicular hemorroidectomy (Milligan and Morgan, Ferguson), the reference operation, to the Longo procedure (stapled hemorrhoidopexy) (SH). SH is easy to perform, is associated with less pain and allows early return to normal activities. Not withstanding a higher risk of recurrence and some degree of procidentia, the long-term level of patient satisfaction is high after SH. Strict patient selection is necessary: patients should have reversible prolapse, normal anal caliber, and absence of large tags. This procedure is not recommended for stage IV disease. In case of persistent prolapse or hemorrhoidal recurrence after SH, elastic band ligation should be preferred.
Topics: Evidence-Based Medicine; Hemorrhoids; Humans; Patient Selection; Rectal Prolapse; Recurrence; Surgical Stapling; Time Factors; Treatment Outcome
PubMed: 25303874
DOI: 10.1016/j.jviscsurg.2014.07.009 -
Journal of Zoo and Wildlife Medicine :... Jan 2023Empirical data suggest that rectal prolapse (RP) is common in captive Sulawesi crested black macaques () in Europe, resulting in the euthanasia of animals that...
Empirical data suggest that rectal prolapse (RP) is common in captive Sulawesi crested black macaques () in Europe, resulting in the euthanasia of animals that experience repeat occurrences. However, the prevalence, etiology, and risk factors of RP remain unidentified. The aims of this retrospective study were to assess the morbidity and mortality of RP, to provide an overview of management practices, and to identify risk factors for RP in this species. A questionnaire was sent to all European Ex situ Programme institutions that housed between 01 January 2014 and 31 December 2020. Zoological Information Management System medical records and the studbook were used to obtain additional information. The questionnaire had a response rate of 65%, accounting for 204 animals. Of these animals, 25 (12.3%) suffered from at least one RP event during the study period and recurrence was noted in 72%. The majority of prolapses reverted naturally, but 28% of afflicted animals were euthanized for this ailment. Institutions with with high frequencies of diarrhea (= 0.035), those that provided diets of ≥90% vegetables and high-fiber pellet ( < 0.001), and those with more male than female ( < 0.001) had increased odds of RP. Institutions that provided fruits daily ( < 0.002) had reduced odds of having RP cases. Although correlation of RP with diet was identified, confounding cannot be excluded, and a detailed dietary analysis needs to take place before altering feeding practices. Acute stressors and detection of protozoa in fecal samples were common findings before an RP event. Demographic analysis indicated that aged females, young males, and subordinate individuals were most affected by this condition. Where tested during an RP intervention, animals had low serum levels of vitamin D. Pedigree analysis hinted at genetic predisposition in this species and requires further investigation.
Topics: Animals; Female; Male; Macaca; Indonesia; Rectal Prolapse; Retrospective Studies; Risk Factors; Morbidity
PubMed: 36640074
DOI: 10.1638/2021-0143 -
Surgery Today May 2023Rectal prolapse after radical surgery for anorectal malformations (ARMs) is a common postoperative complication that causes bleeding and stenosis, and sometimes requires...
PURPOSE
Rectal prolapse after radical surgery for anorectal malformations (ARMs) is a common postoperative complication that causes bleeding and stenosis, and sometimes requires surgical treatment. Different surgical techniques have been reported, but most are associated with high recurrence rates and a long postoperative stay. We performed the hemi-circumferential mucosal resection and anastomosis procedure (HCMR) to preserve anal muscle and anal function. Here, we report the success of our minimally invasive surgical approach to correct rectal prolapse in patients with ARMs.
METHODS
The subjects of this retrospective review were patients who underwent HCMR for rectal prolapse after radical surgery for ARMs between January, 2014 and August, 2021. HCMR involves rectal mucosal resection without muscle plication.
RESULTS
A collective 15 HCMR procedures were performed in 10 patients. The median age at repair was 1.8 years (range, 10 months-18 years). The median operation time and postoperative length of stay were 46 min (range, 17-85 min) and 3 days (range, 1-7 days), respectively. The median postoperative observation period was 3 years 4 months (range, 8 months-7 years 10 months) and no complications or recurrences were observed.
CONCLUSIONS
HCMR is a safe and effective surgical treatment for rectal prolapse after radical operation for ARMs, which is minimally invasive and preserves rectal muscle and function.
Topics: Humans; Infant; Rectal Prolapse; Anorectal Malformations; Follow-Up Studies; Rectum; Treatment Outcome; Anastomosis, Surgical; Postoperative Complications; Recurrence
PubMed: 36282326
DOI: 10.1007/s00595-022-02611-7 -
Journal of Pediatric Surgery May 2019Sclerotherapy is a commonly utilized treatment for rectal prolapse in children. This study systematically evaluates the effectiveness and complications of various... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sclerotherapy is a commonly utilized treatment for rectal prolapse in children. This study systematically evaluates the effectiveness and complications of various sclerosing agents in treating pediatric rectal prolapse.
METHODS
After protocol registration (CRD-42018088980), multiple databases were searched. Studies describing injection sclerotherapy for treatment of pediatric rectal prolapse were included, with screening and data abstraction duplicated. The methodological quality of included papers was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score.
RESULTS
Nineteen studies were identified, published between 1970 and 2017. Most studies were single institution case series, with median "N" 57+/-88.9 and mean MINORS score of 0.51+/-0.17 (perfect score = 1). 1510 patients with a mean age of 4.5 years were accounted for: 36.2% female, most without comorbidities. Mean follow up length was 30 months. The most common sclerosing agent described was ethanol (45%), followed by phenol (33%). The mean number of treatments per patient was 1.1+/-0.34. The overall success rate after a single sclerotherapy treatment was 76.9%+/-8.8%. The overall complication rate was 14.4%+/-2%.
CONCLUSIONS
Injection sclerotherapy appears effective and low-risk in the treatment of pediatric rectal prolapse and should be considered before more invasive surgical options. The available evidence is of relatively poor quality, and prospective comparative investigations are warranted.
LEVEL OF EVIDENCE
3 (meta-analysis of level 3 studies).
Topics: Child; Humans; Rectal Prolapse; Sclerotherapy
PubMed: 30782440
DOI: 10.1016/j.jpedsurg.2019.01.033 -
Colorectal Disease : the Official... Jan 2017Internal rectal prolapse (IRP) is a unique functional disorder that presents with a wide spectrum of clinical symptoms, including constipation and/or faecal incontinence... (Meta-Analysis)
Meta-Analysis Review
AIM
Internal rectal prolapse (IRP) is a unique functional disorder that presents with a wide spectrum of clinical symptoms, including constipation and/or faecal incontinence (FI). The present review aims to analyse the results of trials evaluating the role of abdominal rectopexy in the treatment of IRP with regard to regarding functional and technical outcomes.
METHOD
A systematic review of the literature for the role of abdominal rectopexy in patients with IRP was conducted. PubMed/Medline, Embase and the Cochrane Central Register of Controlled Trials were searched for published and unpublished studies from January 2000 to December 2015.
RESULTS
We reviewed 14 studies including 1301 patients (1180 women) of a median age of 59 years. The weighted mean rates of improvement of obstructed defaecation (OD) and FI across the studies were 73.9% and 60.2%, respectively. Twelve studies reported clinical recurrence in 84 (6.9%) patients. The weighted mean recurrence rate of IRP among the studies was 5.8% (95% CI: 4.2-7.5). Two hundred and thirty complications were reported with a weighted mean complication rate of 15%. Resection rectopexy had lower recurrence rates than did ventral rectopexy, whereas ventral rectopexy achieved better symptomatic improvement, a shorter operative time and a lower complication rate.
CONCLUSION
Abdominal rectopexy for IRP attained satisfactory results with improvement of OD and, to a lesser extent, FI, a low incidence of recurrence and an acceptable morbidity rate. Although ventral rectopexy was associated with higher recurrence rates, lower complication rates and better improvement of bowel symptoms than resection rectopexy, these findings cannot be confirmed owing to the limitations of this review.
Topics: Abdomen; Adult; Aged; Constipation; Digestive System Surgical Procedures; Fecal Incontinence; Female; Humans; Male; Middle Aged; Operative Time; Postoperative Complications; Rectal Prolapse; Rectum; Recurrence; Treatment Outcome
PubMed: 27943547
DOI: 10.1111/codi.13574 -
World Journal of Gastroenterology Jun 2016External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic... (Review)
Review
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
Topics: Defecation; Fecal Incontinence; Humans; Laparoscopy; Postoperative Complications; Recovery of Function; Rectal Prolapse; Risk Factors; Robotics; Surgical Mesh; Treatment Outcome
PubMed: 27275090
DOI: 10.3748/wjg.v22.i21.4977 -
International Urogynecology Journal Feb 2022Laparoscopic sacrohysteropexy (LSH), sacrocolpopexy (LSC) and ventral rectopexy (LVR) with mesh are advocated for surgical treatment of pelvic and rectal prolapse. Our...
INTRODUCTION AND HYPOTHESIS
Laparoscopic sacrohysteropexy (LSH), sacrocolpopexy (LSC) and ventral rectopexy (LVR) with mesh are advocated for surgical treatment of pelvic and rectal prolapse. Our study aims at showing the feasibility of concomitant laparoscopic prolapse repair by comparing perioperative and long-term outcomes of LSH or LSC with and without LVR.
METHODS
This is a retrospective study carried out on 348 women operated on between July 2009 and July 2019. Patients were divided into four groups: (1) LSH only, (2) LSC only, (3) LSH + LVR and (4) LSC + LVR. POP-Q scores and satisfaction questionnaires were recorded at baseline and then annually. Outcomes were defined as subjective failure (vaginal/rectal prolapse symptoms), objective failure (prolapse to/beyond the hymen, full thickness rectal prolapse) or retreatment for prolapse. Complications were collected and graded according to the Clavien-Dindo classification.
RESULTS
Three hundred forty-eight women underwent laparoscopic repair for pelvic and rectal prolapse (219, 44, 66 and 19 in group 1, 2, 3 and 4, respectively). Median follow-up was 24 (4-174) months. Success rate for both rectal and pelvic prolapse was 90.2%. Recurrence rates were not significantly different between the groups (12.3%, 6.8%, 9.1% and 10.5% for groups 1, 2, 3 and 4, respectively). Significant improvement was noticed in satisfaction questionnaires in all groups. There was no difference in perioperative and late complications.
CONCLUSION
The combined laparoscopic procedure appears to be safe and efficient in treating pelvic and rectal prolapse. Appropriate patient selection and available surgical expertise should determine whether to perform these procedures combined or separately.
Topics: Female; Humans; Laparoscopy; Pelvic Organ Prolapse; Rectal Prolapse; Retrospective Studies; Surgical Mesh; Treatment Outcome; Uterine Prolapse
PubMed: 34125240
DOI: 10.1007/s00192-021-04868-x