prolapsse of rectum

Dr. Dinesh. M.GProfessor of SurgeryJ.J.M.M.C.Davangere

Introduction Rectal prolapse was known to mankind as early as 1500

B.C.

Types Partial(Mucosal) prolapseComplete(full-thickness) prolapse

Partial ProlapseMucosa and submucosa of rectum protrude outside anus

for approximately 1-4cmsComposed of double layer of mucous membrane Occurs at the extremes of life

Children: 1-3 yrsElderly

Prolapsed mucous membrane is pink while prolapsed haemorrhoids are plum coloured and pedunculated

Partial prolapse-Aetiopathology

Infants Direct downward course of rectum due to absence of sacral curveDiminished support of anal mucosa due to poor resting anal tone

ChildrenAfter an attack of diarrhoeaSevere whooping coughLoss of weight resulting in reduced fat in ischiorectal fossae

Partial prolapse-Aetiopathology

Adults Associated with 3rd degree haemorrhoidsTorn perineum in femalesStraining from urethral obstruction in malesAtony of anal sphincter in old ageAfter an operation for fistula in ano

Partial prolapse in infants

Differential diagnosis from intussusception

Treatment In infants and children

Digital reposition and treating malnutritionSubmucous injections of phenol in almond oilThiersch’s operation

In adultsSubmucous injectionsExcision of prolapsed mucosa: Goodsall’s ligatureEndoluminal stapling

Thiersch’s operation

Goodsall’s ligature

Complete prolapse(procidentia)

Less common compared to partial prolapseThe protrusion is more than 4 cm in lengthInvolves all layers of the rectal wallThe mucosa is often arranged in a series of circular foldsLax anal sphincterWomen are 6 times more affected and may be associated

with prolapse of uterusFaecal incontinence

Complete rectal prolapse

Complete rectal prolapse

Complete rectal prolapse

Complete rectal prolapse

Complete rectal prolapseTreatment

Abdominal approach Preferred in most cases as it has lower recurrence rates Open or laparoscopic

Perineal approach Preferred in elderly and debilitated patients

Abdominal proceduresMesh rectopexy

Rectum is mobilised completely Non absorbable mesh (prolene) is fixed to presacral fasciaMesh is partially wrapped around the rectum held up in

tension and fixed by stitches

Suture rectopexyResection rectopexy

Combination of anterior resection and mesh rectopexy A good option for patients with significant constipation

Anterior resection

Mesh rectopexy

Abdominal rectopexy

Perineal procedures

Anal encirclement(Thiersch’s operation)Delorme’s mucosal sleeve resection

Rectal mucosa is excised circmferentially from dentate line to the apex of prolapse

The denuded prolapsed muscle is then pleated with a sutureThe transected edges of the mucosa is sutured together

Perineal rectosigmoidectomy

Delorme’s operation

Delorme’s operation

Laparoscopic mesh rectopexy

Thank you