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Innovative Surgical Sciences Jun 2023Rectal prolapse is defined as prolapse of all layers of rectal wallout of the anal sphincter. The aim was to (i) describe the extremely rare combination of a rectal...
OBJECTIVES
Rectal prolapse is defined as prolapse of all layers of rectal wallout of the anal sphincter. The aim was to (i) describe the extremely rare combination of a rectal prolapse with colon cancer in an older female patient, (ii) comment on management-specific aspects and (iii) derive some generalizing recommendations by means of a scientific case report and based on the case-specific experiences related to the clinical management and current references from the medical literature.
CASE PRESENTATION
A 69-year old female patient with cancer of the sigmoid colon at a manifest rectal prolapse was diagnosed. Literature search (using the data bank of "PubMed") resulted in only six patients (the majority of them were females) with the coincidence of rectal prolapse and rectal or colon cancer have been reported so far.
CONCLUSIONS
A patient with a manifest rectal prolapse needs always to undergo colonoscopy and - in case of an ulcer - histological investigation of representative biopsies.
PubMed: 38058771
DOI: 10.1515/iss-2023-0014 -
Annals of Medicine and Surgery (2012) Dec 2022Internal rectal prolapse in children is one of the causes of annoying and drug-resistant constipation. The disease causes a type of obstructive constipation due to the...
OBJECTIVES
Internal rectal prolapse in children is one of the causes of annoying and drug-resistant constipation. The disease causes a type of obstructive constipation due to the appearance of mucosal folds in the distal rectum. If the diagnosis is made in time according to the methods proposed by the author, the treatment can also be done with simple techniques. In this article, the treatment methods for this well-known disease are presented.
METHODS
This is a prospective cross-sectional study, Sixty children (36 girls and 24 boys) between the ages of 6 months and 15 years who have specific symptoms of this disease and different degrees after definitive diagnosis of anesthesia with Delshad-mash have been treated with the sclerosing solution under the rectal mucosa or excision prolapse.
RESULTS
Depending on the severity of the disease, treatment with a subcutaneous injection of sclerosing solution responds well. The condition resolves after years of suffering from high degrees of prolapsed mucosal excision.
CONCLUSION
Diagnosis of internal rectal prolapse can be made based on specific symptoms and barium enema radiology before the anesthesia test for children and determine the patient's treatment path and prevent additional operations such as colostomy-pulmonary with misdiagnosis of Hirschsprung.
PubMed: 36536742
DOI: 10.1016/j.amsu.2022.104886 -
The Indian Journal of Surgery Dec 2015The aim of the study was to assess the clinical and functional results of surgical treatment of female patients with rectal prolapse. In the period of 2003-2010, the...
The aim of the study was to assess the clinical and functional results of surgical treatment of female patients with rectal prolapse. In the period of 2003-2010, the group of 86 female patients (mean age of 67 ± 10) underwent surgery due to rectal prolapse. The group of 24 patients (27.9 %) suffered from mild anal incontinence. They were operated on with open sutured rectopexy (18 pts), Altemeier (45 pts) and Delorme procedure (23 pts). Prior to surgery and after operation, clinical and function results were obtained. The follow-up period amounted to 32 ± 11 months. In perineal approaches, we found mortality in one patient (1.4 %, Delorme) and anastomotic leak in four patients (5.9 %). The recurrence rate in the perineal group was 11.8 % (eight patients). We noted one recurrence in the rectopexy group (5.6 %). The Altemeier procedure revealed the most significant impact on the function of the anal sphincter muscles and resting pressures (42 ± 7 vs 53 ± 9 cm H2O; p = 0.0082). If anterior levatoroplasty was added, the benefits referred also to squeeze pressures (41 ± 8 vs 58 ± 9 cm H2O; p = 0.006 and 42 ± 10 vs 56 ± 9 cm H2O; p = 0.01). In the treatment of rectal prolapse, there is still no consensus about the operation of choice. Selection of the appropriate method should be based on clinical findings and patients' comorbidities to obtain maximal benefits and minimize the postoperative risk and failures.
PubMed: 27011522
DOI: 10.1007/s12262-014-1196-1 -
BMJ Surgery, Interventions, & Health... 2023There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the...
OBJECTIVE
There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the patterns in treatment of rectal prolapse.
DESIGN
A 23-question survey was distributed to the Pelvic Floor Consortium of the American Society of Colorectal Surgeons, the Colorectal Surgical Society of Australia and New Zealand, and the Pelvic Floor Society. Questions pertained to surgeon and practice demographics, preoperative evaluation, procedural preferences, and educational needs.
SETTING
Electronic survey distributed to colorectal surgeons of diverse practice settings.
PARTICIPANTS
249 colorectal surgeons responded to the survey, 65% of which were male. There was wide variability in age, years in practice, and practice setting.
MAIN OUTCOME MEASURES
Responses to questions regarding preoperative workup preferences and clinical scenarios.
RESULTS
In preoperative evaluation, 19% would perform anorectal physiology testing and 70% would evaluate for concomitant pelvic organ prolapse. In a healthy patient, 90% would perform a minimally invasive abdominal approach, including ventral rectopexy (56%), suture rectopexy (31%), mesh rectopexy (6%) and resection rectopexy (5%). In terms of ventral rectopexy, surgeons in the Americas preferred a synthetic mesh (61.9% vs 38.1%, p=0.59) whereas surgeons from Australasia preferred biologic grafts (75% vs 25%, p<0.01). In an older patient with comorbidities 81% would perform a perineal approach. Procedure preference (Delormes vs Altmeier) varied according to location (Australasia, 85.9% vs 14.1%; Europe, 75.3% vs 24.7%; Americas, 14.1% vs 85.9%). Most participants were interested in education regarding surgical approaches, however there is wide variability in preferred methods.
CONCLUSION
There is significant variability in the preoperative evaluation and surgery performed for rectal prolapse. Given the lack of consensus, it is not surprising that most surgeons desire further education on the topic.
PubMed: 38020494
DOI: 10.1136/bmjsit-2023-000198 -
Turkish Journal of Surgery Jun 2021For decades, rectal prolapse has been hypothesized to be caused due to laxity or weakness of the pelvic floor muscles which is often sup- posed to be related to...
OBJECTIVES
For decades, rectal prolapse has been hypothesized to be caused due to laxity or weakness of the pelvic floor muscles which is often sup- posed to be related to childbearing in females. However, 50% of females with rectal prolapse have been reported to be nulliparous and this hypothesis does not explain the incidence of rectal prolapse in males. The aim of this study was to evaluate the role of rectal redundancy in rectal prolapse patho- physiology.
MATERIAL AND METHODS
Nineteen female Sprague Dawley rats (250-300 g) at 16 weeks of age were obtained from the animal center. Rats were divided into two groups as rectal mobilization (study) group (n= 9) and sham-operated control (n= 10) group. In the study group, soft dissection was applied and rectum were mobilized up from the pelvic floor to create a redundant or hypermobilized rectum.The primary outcome was the rate of rectal pro- lapse after rectal mobilization.
RESULTS
As compared to the sham-operated control group, in which none of the rats had rectal prolapse throughout the post-surgical period, rectal prolapse was observed in four of the rats in the rectal mobilization group (0% vs. 44%; p= 0.006). Being unable to increase the length of the rectums of the rats, but using only mobilization to create the redundancy, and the lack of data regarding any adhesions after surgery are the main limitations of this study.
CONCLUSION
This study showed the role of rectal redundancy on the rectal prolapse pathophysiology.
PubMed: 37275185
DOI: 10.47717/turkjsurg.2021.5188 -
The Indian Journal of Surgery Feb 2017Recurrent and chronic rectal prolapse might lead to irreducibility and ultimately gangrene of the rectum if neglected. Gangrenous rectal prolapse is a surgical emergency... (Review)
Review
Recurrent and chronic rectal prolapse might lead to irreducibility and ultimately gangrene of the rectum if neglected. Gangrenous rectal prolapse is a surgical emergency and needs urgent surgical management. In view of irreducibility and gangrenous bowel, it is not advisable to attempt manual reduction of rectal prolapse. The only safe option that remains is perineal rectosigmoidectomy (Altemeier's operation). Here, we present our experience of five such cases operated in our institute from 2000 to 2015 with available literature review.
PubMed: 28331266
DOI: 10.1007/s12262-016-1562-2 -
Frontiers in Surgery 2023Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with...
Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with traces of blood and mucus and had experienced fatigue after hiking. After the initial evaluation, it became clear that prolapse bares a large rectal tumor as a leading point. The prolapse was reduced under general anesthesia, along with a tumor biopsy. Further workup confirmed locally advanced adenocarcinoma of the rectum, which was treated with neoadjuvant chemoradiation followed by curative surgery in another hospital after repatriation. Rectal prolapse affects people of all ages, but it is more common in older adults, particularly women. Treatment options vary depending on the severity of the prolapse and can range from conservative measures to surgical interventions. This case report highlights the importance of early recognition and appropriate management of rectal prolapse in the emergency setting and the possibility of an underlying malignancy.
PubMed: 37114157
DOI: 10.3389/fsurg.2023.1176726 -
Journal of the Anus, Rectum and Colon 2018Although various pelvic floor abnormalities are recognized to cause mucus discharge (MD), little is known about the exact distribution and frequency of diseases causing...
OBJECTIVES
Although various pelvic floor abnormalities are recognized to cause mucus discharge (MD), little is known about the exact distribution and frequency of diseases causing MD in evacuatory disorders. This study aimed to identify the most common diseases at evacuation proctography in patients with MD.
METHODS
Patients seen with symptoms of evacuatory disorder underwent proctography. Data for patients with MD who were not associated with fecal incontinence (FI) were prospectively entered into a database and analyzed retrospectively. The degree of MD was documented using FI Severity Index.
RESULTS
Sixty-two patients were included for analysis. Forty-nine (79%) had rectal intussusception (RI) or external rectal prolapse (ERP). Of those with RI, MD was observed more in patients with recto-anal intussusception (n = 22) than those with recto-rectal intussusception (n = 8). Of the 39 patients who were not associated with hemorrhoids or mucosal prolapse, 31 (79%) had RI or ERP. Meanwhile, of 582 patients who underwent proctography, 301 had RI and 96 had ERP. MD without FI was present in 13% (40/301) patients with RI and 9% (9/96) with ERP. Surgery was performed in 21 patients, and MD was cured in 20 (95%) postoperatively.
CONCLUSIONS
RI and ERP were common at proctography in patients with MD.
PubMed: 31559356
DOI: 10.23922/jarc.2018-003 -
Techniques in Coloproctology Nov 2017The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information... (Review)
Review
BACKGROUND
The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery.
METHODS
This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch-Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0).
RESULTS
Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch-Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2-85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1-5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1-8).
CONCLUSIONS
Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.
Topics: Comprehension; Consumer Health Information; Decision Making; Humans; Internet; Patient Education as Topic; Rectal Prolapse
PubMed: 29101494
DOI: 10.1007/s10151-017-1708-7