Random medical images gallery

Hallux rigidus

User login

Home | Viva | Operative Surgery | General Surgery

Rectal prolapse

Predisposition

  1. Anatomy - continence maintained by 120' pubo-rectalis sling
    • Children; direct downward course of rectum (undeveloped sacral curve)
    • Maldevelopment of pelvis
    • Female - torn perineum (pregnancy)
    • Weak pelvic floor
  2. Constipation / straining
    • Diarrhoea (in children)
    • Straining
    • Haemarrhoids

 

Classification

 

  Pathology Treatment
Complete

Full thickness prolapse of rectum through anus

  • Weakness of levator ani
  • Starts at weak anterior wall
  • Protrudes 10-15cm in lenght
  • Contains pouch of peritoneum anteriorly (which can sometimes contain small intestine)
  1. Perineal approach
    • Delorme's operation - rectal mucosa removed circumferentially from prolapsed rectum; sutured in "concertina" fashion to reduce prolapse and create ring of muscle within anal canal - narrows orifice and prevents recurrence
  2. Abdominal approach
    • Wells operation - rectum fixed firmly to sacrum by inserting sheet of polypropelene mesh between them
    • Suture rectopexy - 4-6 interrupted sutures used to fix rectum to sacrum
Incomplete/partial (mucosal) Mucous membrane + submucosa of rectum protrude outside of anus
  1. Digital repositioning
  2. Phenol submucous injections
  3. Excision of prolapsed mucosa
Concealed Intersusseption of upper anus into rectum
  1. Laxatives / stool bulking agents
  2. Dietary modifications

 

 

Login or register to post comments
© www.surgicalnotes.co.uk 2007 - 2011