q Definition:
Protrusion of rectal wall (complete) or rectal mucosa (partial) through the anal orifice.
q Aetiology:
(I). In children:
- Increase straining due to dysentry & G.E or whooping cough.
- Decrease support e.g. loss of perirectal fat as in marasmus.
(II) In adult:
mIncrease strainingdue to urethral stricture or chronic cough.
mDecrease support as in cases of :
Senility ® weakness of pelvic floor
Injury of pelvic floor during labour in Female
Injury of Ext. sphincter after anal operation.
mTraction on mucosa as in cases of:
Prolapsed piles. Bilharzial polyps.
q Pathology & Cl. picture:
Types:
1- Partial prolapse: Only mucosa protrudes.
2- Complete prolapse:
The whole wall protrudes. The rectovesical pouch may descend with rectal wall and protrudes from the anus & small intestine descends in it ® sliding hernia.
q Complications:
1- Ulceration of the mucosa.
2- Bleeding due to rupture of submucous veins.
3- Irreducibility and gangrene.
4- Faecal incontinence.
q Treatment:
(I) Partial Prolapse:
A) Infants and Children:
1- Digital reposition: with the index finger wrapped in kleenex tissue then the finger is withdrawn leaving the kleenex tissue to disintegrate.
2- Submucous injection: of 5% phenol in almond oil.
3- Thiersch's circulage: Encircling the anus by nonabsorbable suture ® fibrosis ® prevent prolapse in front of straining.
B) In adults:
1- Submucous injection.
2- Ligature excision of the prolapsedmucosa. (Goodsall's suture)

(II) Complete Proplase:
Operation is required and whenever possible abdominal rectopexy is recommended.
A) Abdominal rectopexy operations:
1. Wells'operation: Polyvinyl sponge is sutured to the periosteum over the midline of the sacrum and to both sides of the rectum. It gives the best results.
2. Rebstein's operation:The rectosigmoid junction is hitched up by a Teflon sling to the front of the sacrum just below the promontory.
3. Lahaut's operation: Traction on the rectum is done by extraperitonealising it through the rectus sheath. The results are moderate.
B) Perineal approach:
1. Delorme's operation: Excision of the redundant mucosa and plication of the underlying musscle.
2. Thiersch 's circulage.
SOURCE: DR. AYMAN SALEM'S BOOK
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