Rectal Prolapse

Question 1

What is rectal prolapse?

Answer 1

Descend of the rectal wall through the lower rectum &/or anal canal to protrude outside the anus

Question 2

What are the types of rectal prolapse?

Answer 2

INTERNAL RP -> occult

EXTERNAL RP

• partial rectal prolapse
• complete rectal prolapse

Question 3

What is the difference between partial & complete rectal prolapse?

Answer 3

PARTIAL COMPLETE
- mucosa only - whole thickness of rectal wall
- thin - thick
- < 5cm - > 5cm
CAUSED BY
- loss of weight - prolonged straining
- prolonged straining - abnormal fixation of rectum
- defect of anal sphincter
- advanced hemorrhoids

Question 4

What will internal rectal prolapse lead to?

Answer 4

invagination of the proximal rectal wall inside the distal segment without protrusion from the anus -> obstructed defecation

Question 5

What is the clinical picture of rectal prolapse?

Answer 5

• mass protruding from anus -> increase with straining
• mucous discharge
• obstructed defecation
• picture of complications

Question 6

What are the complications of rectal prolapse?

Answer 6

• irreducibility
• strangulation
• ulceration
• bleeding
• faecal incontinence

Question 7

What investigations are used to diagnose rectal prolapse?

Answer 7

• anorectal manometry
• defecography
• sigmoidscopy -> exclude any pathology or tumor

Question 8

How should partial rectal prolapse be treated?

Answer 8

• treat THE CAUSE
• digital reposition in children
• submucous injection of the alcohol to induce fibrosis
• THEIRSCH OPERATION: peri-anal circlage
• GOODSALL operation: excision of excess mucosa

If severe & recurrent treat as complete RP

Question 9

What is the standard operation in complete rectal prolapse?

Answer 9

POSTERIOR RECTOPEXY

- fixation of posterior rectal wall to sacral promontory

Question 10

When is resectional rectopexy done?

Answer 10

In complete rectal prolapse involving long sigmoid

- sigmoidectomy “redundant colon” with posterior rectopexy

Question 11

When is Altemier’s operation done?

Answer 11

Gangrenous rectum

- resection of the whole thickness of the prolapsed rectum, then reanastomosis

Question 12

What is ventral rectopexy?

Answer 12

Fixation of the anterior rectal wall to the SACRAL promontory

Question 13

What is Delorme’s operation?

Answer 13

Resection of the prolapse excess mucosa, then suturing with plication of the underlying submucosa