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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 -
The Australian and New Zealand Journal... Feb 1979One hundred and twenty-seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an...
One hundred and twenty-seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an older age in females (mean age 55 years compared with 40 years for males). Although the diagnosis is usually obvious, the importance of recognizing occult prolapse is stressed, especially in association with benign rectal ulcer, localized proctitis and colitis cystica profunda. Examination of the patient in the squatting position may assit in showing occult prolapse. Associated incontinence occurred in 33 patients (26%). Since 1971 the policy of this Unit has been to perform a Ripstein repair for complete rectal prolapse wherever possible. One hundred and two Ripstein repairs have not been performed. A minimum follow-up period of two years is available for 53 patients, of whom 50 (94%) have had their prolapse cured. Control of prolapse usually improves continence; however, seven (13%) remained incontinent despite surgery. The Ripstein repair is strongly advocated as the most effective operation for cure of complete rectal prolapse.
Topics: Adolescent; Adult; Aged; Female; Follow-Up Studies; Humans; Male; Methods; Middle Aged; Postoperative Complications; Rectal Prolapse
PubMed: 288434
DOI: 10.1111/j.1445-2197.1979.tb06440.x -
Gastroenterology Clinics of North... Sep 2008Rectal prolapse is best diagnosed by physical examination and by having the patient strain as if to defecate; a laparoscopic rectopexy is the preferred treatment... (Review)
Review
Rectal prolapse is best diagnosed by physical examination and by having the patient strain as if to defecate; a laparoscopic rectopexy is the preferred treatment approach. Intussusception is more an epiphenomena than a defecatory disorder and should be managed conservatively. Solitary rectal ulcer syndrome is a consequence of chronic straining and therapy should be aimed at restoring a normal bowel habit with behavioral approaches including biofeedback therapy. Rectocele correction may be considered if it can be definitively established that it is a cause of defecation disorder and only after conservative measures have failed. An enterocele should only be operated when pain and heaviness are predominant symptoms and it is refractory to conservative therapy.
Topics: Female; Hernia; Herniorrhaphy; Humans; Intussusception; Rectal Prolapse; Rectocele; Syndrome; Ulcer
PubMed: 18794001
DOI: 10.1016/j.gtc.2008.06.001 -
Diseases of the Colon and Rectum Jul 1985Rectal prolapse in children is an uncommon clinical entity in western countries. Treatment is generally supportive with surgery reserved for the intractable case. If... (Review)
Review
Rectal prolapse in children is an uncommon clinical entity in western countries. Treatment is generally supportive with surgery reserved for the intractable case. If operative intervention is advised, it should consist of one of several limited procedures that can be safely performed with low morbidity: anal encirclement, presacral packing, sclerosing injection, or linear rectal cauterization.
Topics: Child, Preschool; Humans; Infant; Rectal Prolapse; Sclerosing Solutions
PubMed: 3893949
DOI: 10.1007/BF02554107 -
Journal of Paediatrics and Child Health Jul 2021
Topics: Humans; Rectal Prolapse
PubMed: 32889783
DOI: 10.1111/jpc.15133 -
World Journal of Gastroenterology Apr 2015To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse. (Review)
Review
AIM
To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.
METHODS
MEDLINE, PubMed, EMBASE, and other relevant database were searched to identify studies. Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.
RESULTS
Twelve non-randomized case series studies with 574 patients were included in the review. No surgical mortality was described. Conversion was needed in 17 cases (2.9%), most often due to difficult adhesiolysis. Twenty eight patients (4.8%) presented with major complications. Seven (1.2%) mesh-related complications were reported. Most frequent complications were urinary tract infection and urinary retention. Mean recurrence rate was 4.7% with a median follow-up of 23 mo. Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%. Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages. Evaluation of functional score was disparate between studies.
CONCLUSION
Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.
Topics: Constipation; Digestive System Surgical Procedures; Fecal Incontinence; Humans; Laparoscopy; Postoperative Complications; Recovery of Function; Rectal Prolapse; Recurrence; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25945021
DOI: 10.3748/wjg.v21.i16.5049 -
The Central African Journal of Medicine Dec 1994This is a retrospective report of nine patients with complete rectal prolapse managed by the authors at the Muhimbili Medical Centre, Dar es Salaam between 1990 and... (Review)
Review
This is a retrospective report of nine patients with complete rectal prolapse managed by the authors at the Muhimbili Medical Centre, Dar es Salaam between 1990 and 1993. The average age of patients was 36 years and eight of the patients were males. Six of the patients presented as emergency admissions of whom three had irreducibility and required perineal proctosigmoidectomy. This was the procedure of choice for irreducible complete rectal prolapse.
Topics: Adult; Aged; Colon, Sigmoid; Emergencies; Female; Humans; Male; Middle Aged; Rectal Prolapse; Rectum; Retrospective Studies; Tanzania
PubMed: 7882416
DOI: No ID Found -
Primary Care Mar 1999Rectal prolapse and fecal incontinence are problems with enormous social, functional, and economic significance to hundreds of thousands of people every year. Through a... (Review)
Review
Rectal prolapse and fecal incontinence are problems with enormous social, functional, and economic significance to hundreds of thousands of people every year. Through a knowledgeable approach and careful diagnostic studies, many people can be cured or helped.
Topics: Fecal Incontinence; Female; Humans; Male; Rectal Prolapse; Sex Factors
PubMed: 9922297
DOI: 10.1016/s0095-4543(05)70104-4 -
The Surgical Clinics of North America Feb 1997Rectal prolapse remains a disorder for which the cause is not clearly understood and the best method of management is debated. Because the natural history of prolapse... (Review)
Review
Rectal prolapse remains a disorder for which the cause is not clearly understood and the best method of management is debated. Because the natural history of prolapse frequently leads to complications of incontinence and constipation, we believe that all patients presenting with internal and external prolapse should be considered for repair. Although the type of operative repair recommended may vary, it is clear that all patients with external rectal prolapse should be offered some type of repair. What is not clear from the literature is the appropriate management of those patients with internal prolapse. As shown in the George Washington University experience, surgery is rarely performed for isolated internal prolapse. Most patients who present with internal prolapse also have an associated enterocele, rectocele, or cystocele. Repair of the internal prolapse and the associated disorder may benefit many of these patients. If internal prolapse is an isolated finding, it is not clear to what extent the prolapse is responsible for the patient's symptoms, and repair is generally not advised. These guidelines are easy to enumerate but may be difficult to practice in some patients. Therefore, ongoing evaluation of clinical results is critical to improve our understanding of these disorders. This discussion has outlined the current theories of the cause of rectal prolapse, the symptoms and findings patients present with, and the possible approaches to repair.
Topics: Colorectal Surgery; Humans; Physical Examination; Rectal Prolapse; Rectum; Surgical Mesh; Treatment Outcome
PubMed: 9092117
DOI: 10.1016/s0039-6109(05)70532-6 -
Bratislavske Lekarske Listy 2010It is not so much the diagnosis that offers the surgeon a wide range of opportunities in the technical solutions of rectal prolapse. Currently there are at least 130...
It is not so much the diagnosis that offers the surgeon a wide range of opportunities in the technical solutions of rectal prolapse. Currently there are at least 130 different techniques used in the surgical treatment of rectal prolapse and in fact none of these procedures has been shown most effective for any one patient. In this study, our intent is to describe the experiences of the authors with the treatment of rectal prolapse, to estimate the actual level of expertise of the surgeons in treatment of rectal prolapse, and to describe in which way to proceed in the future (Tab. 4, Fig. 3, Ref. 27). Full Text (Free, PDF) www.bmj.sk.
Topics: Humans; Rectal Prolapse
PubMed: 20429325
DOI: No ID Found