Rectal Tear and Prolapse Flashcards
What is a grade 1 rectal tear?
mucosa and submucosa are torn
What is a grade 2 rectal tear?
- muscular layer disrupted
- mucosa and submucosa may prolapse into defect
What is a grade 3a rectal tear?
all layers except for serosa
What is a grade 3b rectal tear?
involves mesorectum and retroperitoneal tissue
What is a grade 4 rectal tear?
all layers into abdomen
Where are most rectal tears located?
dorsally
15-55cm from anus
What is the initial treatment for a rectal tear?
- antibiotics, fluids, Flunixin
- reduction of rectal motility
- removal of feces
- gentle packing of rectum
What is the non-surgical treatment for a grade 1 or 2 rectal tear?
- antibiotics and Flunixin
- soften feces (mineral oil, bran, moistened pellets)
What is the non-surgical treatment for a grade 3 rectal tear?
- frequent manual removal of feces
- peritoneal lavage
What are the surgical techniques/treatments for rectal tears?
- direct suture repair
- temporary indwelling rectal liner
- loop colostomy
Describe direct suture repair of a rectal tear
- epidural
- stay sutures in anus
- prolapse the tear, staple with TA90, continuous suture
Describe temporary indwelling rectal liner
- protects tear and allows it to heal spontaneously
- make liner by gluing palpation sleeve to rectal prolapse
- secure liner oral to tear
When is a loop colostomy indicated?
- grade 4 +/- grade 3 rectal tear
- tear > 25% of rectal diameter
- tear > 50 cm from anus
What is a type 1 rectal prolapse?
only mucosa projects through anus
What is a type 2 rectal prolapse?
prolapse of all layers of rectum
