SUR.LECT8 rectal prolapse ( 4 )

*Strictures of anal canalnon-malignant and malignant strictures *Pruritis ani *Anal incontinence

Rectum

Anatomy

Rectal injuries: 1- Falling in sitting posture 2- Fetal head 3- F.B. 4- sigmoidoscopy, enema 5- compressive air rupture 6- Bullet injury

Management

.Resuscitation ABC. .Exclude urethral injury. CT Scan of the abdomen .Exam rectum under anesthesia .Lower laparotomy –intraperitoneal(closure&colostomy)or resection and hartmann’s procedure Extraperitoneal( defunctioning colostomy +presacral drain)

Rectal prolapse

Dr.Sardar Hassan Arif CABS,FICMS ,FACS

Divided to:

A- Mucosal (Partial) P.:Mucous membrane and submucous of rectum protrude out side the rectum for approximately 1-4 cmOccure usually in childrenAE/Infant :-undeveloped sacral curve - reduce resting anal toneChildren: - attacks of diarrhoea – loss of weight - associated fibrocystic disease ,neurological causes & maldevelopment of pelvis Adult : - ass. With 3rd degree H. - in female torn perineum - straining from urethral obstruction - follow operation for fistula in ano

Diagnosis

- By history - Prolapsing mass during defecation - exam. Prolapsed mucous membrane is pink Differential diagnosis: Haemorrhoid : plum colored and more pedunculated


Treatment
In infant and children : 1- digital reposition for 6 weeks 2- Submucous injection:5% phenol in almond oil under GA 3- Surgery: retrorectal space entered or Thiersch operation: In adult : 1- submucous injections: 2- Excision of prolapsed mucosa 3- endoluminal stapling technique

B- complete P.( procidentia)

Less common, the protrusion consist of all layers of the rectal wall &it is desend of rectum down ward through the levator ani (rectum intussuscepts upon itself) Process start with The anterior wall of rectum where the Supporting tissues are Weakest esp. women

On exam.

To differentiate from partial1- it is > 4 cm 10-15 cm2- prolapsed mucosa arranged in semicircular folds3- on palpation Feel (between fingers and thumb)Much thicker than partial (double thickness)Anteriorly some time containing small intestine –large pouch when return to abdomen with gurgle 4- on reduction of prolapse anus looks patulous and gapes widely


Complete type is uncommon in children More common in elderly specially female >male –8 times Some time ass. With prolapsed uterusThere may past history of Gynecological operation e.g. hysterectomy Important in complete P.:1- Exclude underline malignancy2- about 50% complete P. in young male ass. With faecal incontinence------ so investigations

D . D : ileocaecal intussusceptions

Treatment
Perineal approach :- Old age- Injury to spinal cord- Very early life1- Delorme’s operation:2- Thiersch operation:3- perineal rectosigmoidectomy(Altemeier)

Abdominal approach:Patient in good health1- Wells’ operation(rectopexy)2- Ripstein’s rectopexy3- Lahauts’ operation4- Low anterior resection rectum and end to end anastmosis