Rectal prolapse Flashcards
1
Q
What is a rectal prolapse?
A
- Protrusion of mucosal or full thickness layer of rectal tissue out of the anus
- Quite uncommon
- Mainly older females
2
Q
Two types of rectal prolapse
A
- Partial thickness - rectal mucosa protrudes out the anus
- Full thickness - rectal wall protrudes out the anus
3
Q
Pathophys of rectal prolapse - full vs partial
A
- Full prolapse - form of sliding hernia through a defect of fascia in pelvis - this may be caused by chronic straining secondary to constipation, cough or multiple vaginal deliveries
- Partial thickness - loosening and stretching of connective tissue that attaches rectal mucosa to rectal wall - related to long standing haemorrhoidal disease
4
Q
RF for rectal prolapse
A
- Increasing age
- Female gender
- Multiple deliveries
- Straining
- Anorexia
- Previous traumatic vaginal delivery
5
Q
Symptoms of rectal prolapse
A
- Rectal mucus discharge
- Faecal incontinence
- PR bleeding
- Visible ulceration
6
Q
Extra symptoms of full thickness prolapse - initial
A
Starts internally so can initially present with:
* Rectal fullness
* Tenesmus
* Repeated defecation
7
Q
Examination for rectal prolapse
A
- May not always be evident - get patient to strain
- DRE identifies weakened anal sphincter
- If internal suspected - defecating proctography (MRI wile defecating) and EUA may be needed
8
Q
Conservative management rectal prolapse
A
- If unfit for surgery or minimal symptoms
- Increasing dietary fibre and fluid intake
- Minor mucosal prolapses can be banded - BUT prone to recurrence
9
Q
Surgical management for rectal prolapse two approaches
A
Definitive management:
* Perineal approach or
* Abdominal approach
10
Q
Perineal approach surgery
A
- Delormes operation - prolapsed lining of rectal mucosa is removed and underlying muscle reinforced with plicated sutures (deep sutures)
- Altemeiers op - resection of abundant prolapsed bowel to restore original anatomy
11
Q
Abdominal approach
A
- Laparoscopically usually, robotically or open
- Rectopexy - rectum mobilised and fixed onto sacral prominence via sutures or mesh
12
Q
Which op is better?
A
- No difference in post op outcomes
- Perineal procedures preferred in older patients as considered safer
13
Q
A