In addition to definitive management of rectal prolapse, any underlying risk factors e. Clinical science Rectal prolapse is the protrusion of rectal mucosa mucosal prolapse or the entire rectum full-thickness prolapse through the anal opening. Depending on the severity of the rectal prolapse, rectal prolapse may be classified as: Mucosal prolapse partial prolapse Protrusion of the rectal mucosa through the anus Typically less than 4 cm in length Much more common in children and infants Full-thickness prolapse complete prolapse U sually begins as a rectal intussusception ; therefore, all layers of the rectal wall protrude through the anus.
Symptoms A painless rectal mass that protrudes through the anus Fecal incontinence Constipation Pruritus ani Rectal bleeding Physical examination The perineum should ideally be examined while the patient squats or strains.
- Rectal Prolapse: Diagnosis and Clinical Management?
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- Rectal prolapse.
The rectum protrudes partially or completely through the external anal opening. Mucous prolapse Radial mucosal folds are seen on inspection Only a double layered mucous membrane can be palpated.
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Full-thickness prolapse Concentric mucosal folds are seen on inspection stacked-coin appearance All four layers of the rectal wall can be palpated. A sulcus or groove may be present between the emerging mass and the walls of the anal canal.
Digital rectal examination may reveal anal sphincter weakness and a mass or other pelvic floor pathology.. Other conditions associated with pelvic floor weakness e. Definitive diagnosis Rectal prolapse is primarily a clinical diagnosis. If a rectal ulcer is present: Mucosal prolapse Mucosal prolapse is generally managed nonsurgically. Delorme procedure Long, full-thickness prolapse that cannot be treated by abdominal procedures: Altemeier procedure perineal rectosigmoidectomy While surgery is performed electively in most cases, incarcerated rectal prolapse should be treated as a surgical emergency!
Altomare - Pucciani Rectal Prolapse - Diagnosis and Clinical Management Springer Verlag
Throughout the history of medicine, multiple approaches to the treatment of rectal prolapse have been described. In the past century, its management has evolved a great deal due to accumulation of knowledge obtained from physiologic investigations and follow up of surgical series[ 4 ].
However, technical details, indications, and outcomes of these new techniques are not widely understood. The richness and variety of choices for treating rectal prolapse may become confusing, and controversial. These are some reasons why many surgeons feel the need for one articulate and comprehensive volume that present an all inclusive understanding of the pathophysiology of rectal prolapse and state of the art surgical treatment for it.
It deals comprehensively with the various forms of prolapse, including external prolapse, rectal intussusception and genital prolapse.
Rectal prolapse: Diagnosis and clinical management
The chapters on etiology and investigation set out in detail the present position regarding the value of the advancements in clinical practice. Beside the classic operations, new treatment modalities such as the STARR and EXPRESS procedures are dealt with, and their indications are considered in relation to the clinical presentation and the various other options.
Function following surgery receives considerable attention and the difficult problems that may be posed by recurrence after surgery are dealt with. Non surgical treatment and rehabilitation are also described in this book. The book, is beautifully laid out with very clear illustrations including high quality operative color photographs and line drawings.
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It is important not only to surgeons but also to gastroenterologists, physiologists and radiologists. National Center for Biotechnology Information , U. Journal List World J Gastroenterol v. Published online May 7.
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- Rectal prolapse – Knowledge for medical students and physicians.
- Rectal prolapse: Diagnosis and clinical management?
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Mostafa RM solely contributed to this book review. Abstract The exact cause of rectal prolapse is not well addressed, but it is often associated with long standing constipation, advanced age, chronic obstructive pulmonary disease and some neurological disorders.
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