Rectal Prolapse Flashcards

1
Q

What is rectal prolapse?

A

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

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2
Q

What are the types of rectal prolapse?

A

INTERNAL RP -> occult

EXTERNAL RP

  • partial rectal prolapse
  • complete rectal prolapse
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3
Q

What is the difference between partial & complete rectal prolapse?

A

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

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4
Q

What will internal rectal prolapse lead to?

A

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

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5
Q

What is the clinical picture of rectal prolapse?

A
  • mass protruding from anus -> increase with straining
  • mucous discharge
  • obstructed defecation
  • picture of complications
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6
Q

What are the complications of rectal prolapse?

A
  • irreducibility
  • strangulation
  • ulceration
  • bleeding
  • faecal incontinence
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7
Q

What investigations are used to diagnose rectal prolapse?

A
  • anorectal manometry
  • defecography
  • sigmoidscopy -> exclude any pathology or tumor
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8
Q

How should partial rectal prolapse be treated?

A
  • 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

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9
Q

What is the standard operation in complete rectal prolapse?

A

POSTERIOR RECTOPEXY

- fixation of posterior rectal wall to sacral promontory

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10
Q

When is resectional rectopexy done?

A

In complete rectal prolapse involving long sigmoid

- sigmoidectomy “redundant colon” with posterior rectopexy

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11
Q

When is Altemier’s operation done?

A

Gangrenous rectum

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

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12
Q

What is ventral rectopexy?

A

Fixation of the anterior rectal wall to the SACRAL promontory

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13
Q

What is Delorme’s operation?

A

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

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