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
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2
Q

Two types of rectal prolapse

A
  • Partial thickness - rectal mucosa protrudes out the anus
  • Full thickness - rectal wall protrudes out the anus
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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
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4
Q

RF for rectal prolapse

A
  • Increasing age
  • Female gender
  • Multiple deliveries
  • Straining
  • Anorexia
  • Previous traumatic vaginal delivery
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5
Q

Symptoms of rectal prolapse

A
  • Rectal mucus discharge
  • Faecal incontinence
  • PR bleeding
  • Visible ulceration
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6
Q

Extra symptoms of full thickness prolapse - initial

A

Starts internally so can initially present with:
* Rectal fullness
* Tenesmus
* Repeated defecation

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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
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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
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9
Q

Surgical management for rectal prolapse two approaches

A

Definitive management:
* Perineal approach or
* Abdominal approach

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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
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11
Q

Abdominal approach

A
  • Laparoscopically usually, robotically or open
  • Rectopexy - rectum mobilised and fixed onto sacral prominence via sutures or mesh
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12
Q

Which op is better?

A
  • No difference in post op outcomes
  • Perineal procedures preferred in older patients as considered safer
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13
Q
A
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