Rectal prolapse Flashcards
What is prolapse?
When an organ falls or sinks out of its normal anatomical position.
What is a complete vs occult rectal prolapse?
Complete: rectum protrudes through anus
Occult: rectal prolapse without protrusion through anus
What fx precipitate development of rectal prolapse?
Age, repeated childbirth, constipation, ongoing physical activity, heaving lifting, prolapse of other pelvic organs, hysterectomy.
What are the symptoms of rectal prolapse?
- protrusion of the rectum during and after defecation
- faecal incontinence
- constipation
- rectal bleeding
- females: vaginal bulge/pressure, painful intercourse
Gender of rectal prolapse?
Female 6:1 male
which surgical approaches may be used to treat rectal prolapse?
Abdominal approach: rectopexy or anterior resection
Perineal approach: Altmeir’s, Delorme’s
What is a rectopexy?
Incision into abdomen, isolation of rectum, rectum lifted and fixed to sacrum with stitches/mesh.
What is an anterior resection?
Removal of the sigmoid colon, reattachment of cut ends.
May be combined with rectopexy (lower recurrence rate).
What is the Altmeier procedure?
Aka proctosigmoidectomy.
Prolapsed portion of rectum resected and cut ends reattached. Weakened support structures re-sutured into place.
What is the Delorme procedure?
Resection of only mucosa of prolapsed rectum. Exposed muscular layer folded and stitched with cut edges of mucosa reattached.
Physical examination features of rectal prolapse?
Patient asked to strain as if defecating ==> intraabdominal pressure maximises prolapse.
