[26] Rectal Prolapse Flashcards
What is a rectal prolapse?
Where a mucosal or full-thickness layer of rectal tissue protrudes out of the anus
How common is a rectal prolapse?
Relatively uncommon
Who do rectal prolapses mainly affect?
Women greater than 30 years of age
What are the main types of rectal prolapse?
Partial thickness
Full thickness
What is a partial thickness rectal prolapse?
Where the rectal mucosa protrudes out of the anus
What is a full thickness rectal prolapse?
When the rectal wall protrudes out of the anus
What are the current theories regarding the pathophysiology of a full prolapse?
It is a form of sliding hernia, through a defect of the fascia of the pelvic region
What can cause a defect in the fascia of the pelvic region?
Chronic straining secondary to constipation
Chronic cough
Multiple vaginal deliveries
What is the pathophysiology of partial thickness prolapses?
Associated with loosening and stretching of the connective tissue that attaches the rectal mucosa to the remainder of the rectal wall
What do partial thickness prolapses often occur in conjunction with?
Long-standing hemorrhoidalfa disease
What are the symptoms of a rectal prolapse?
Rectal mucus discharge
Faecal soiling
Bright red blood on wiping
Visible ulceration
What is the result of full thickness prolapses beginning internally on their presentation?
They can present as rectal fullness, tenesmus, or repeated defecation
How does a prolapse progress?
With time, the rectum begins to prolapse with defecation, then later with minimal coughing and straining, eventually becoming completely external
Which type of prolapse is particularly prone to ulceration?
External prolapse
What may be found on examination in rectal prolapse?
The prolapse may not always be evident, but can be identified by asking the patient to strain
Weakened sphincter on DRE
How is a suspected internal prolapse investigated to confirm the diagnosis?
Defecating proctography
Examination under anaesthesia
Who is the conservative management of rectal prolapse particularly useful in?
Those unfit for surgery
Those with minimal symptoms
Children
Why is conservative management of rectal prolapse particularly useful in children?
As most prolapses will resolve spontaneously
What does the initial conservative management of rectal prolapse involve?
Improved dietary fibre and fluid intake, to reduce constipation and the time spent straining
What management might minor mucosal prolapses undergo in clinic?
Banding
What is the limitation of banding minor mucosal prolapses?
Prone to recurrence
What is the only definitive management of a rectal prolapse?
Surgical repair
What are the surgical options for the management of rectal prolapse?
Abdominal approach
Perineal approach
What is the decision between abdominal and perineal approach determined by in rectal prolapse surgery?
The patient’s age and co-morbidities
What are the options for perineal approach to rectal prolapse surgery?
Delormes operation
Altmeirs operation
What does a Delormes operation involve?
Part of the prolapsed lining of the rectal mucosa being removed, and the muscle of the rectum reinforced with placating stitches
What is an Altmeirs operation?
Perineal excision of sigmoid colon and rectum
What is the abdominal approach to rectal prolapse surgery called?
Rectopexy
What does a rectopexy involve?
The rectum being mobilised and fixed onto the sacral prominence
How do Altmeirs and Delormes operations compare to each other?
Altmeirs operation carries the risks associated with a resection, but is is often more effective
