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Rincon-Cruz L, Staffa SJ, Dickie B, Nandivada P. Influence of Initial Treatment Strategy on Outcomes for Children With Rectal Prolapse. J Pediatr Gastroenterol Nutr 2023; 77:603-609. [PMID: 37889618 DOI: 10.1097/mpg.0000000000003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Pediatric rectal prolapse is a common and often self-limited condition with multiple management options. Selecting the optimal approach requires personalization and remains a challenge for pediatricians and pediatric surgeons. METHODS A single-center retrospective review of 67 children with rectal prolapse undergoing surgical evaluation between 2010 and 2021. Patients with anorectal malformations, Hirschsprung disease, inflammatory bowel disease, and cystic fibrosis were excluded. We used multivariable logistic regression to compare medical management, sclerotherapy, and surgical correction (rectopexy or transanal resection) as initial treatment strategies, with a primary endpoint of prolapse resolution. RESULTS Younger patients (<5 years) were more likely to be initially treated with medical management alone (P < 0.001). Patients with a psychiatric diagnosis were more likely to be offered either sclerotherapy or surgery upfront (P = 0.009). The resolution rate with surgery as initial management was 79% (n = 11/14). The resolution rate with sclerotherapy as initial management was 54% (n = 13/24), with 33% (n = 8/24) resolving with sclerotherapy alone and 21% (n = 5/24) resolving after a subsequent surgical procedure (P = 0.011). Patients who underwent initial surgical management had an adjusted odds ratio of 8.0 (95% CI: 1.1-59.1; P = 0.042) for resolution of prolapse compared to patients who underwent sclerotherapy initially. Markers of severity (bleeding, need for manual reduction) were not associated with initial therapy offered (P = 0.064). CONCLUSIONS Surgical intervention (sclerotherapy, rectopexy, transanal resection) resolved rectal prolapse in most children (63%). Surgery as an initial management approach had a significantly higher success rate than sclerotherapy, even after controlling for severity of disease, psychiatric diagnosis, need for manual reduction, and age.
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Short SS, Wynne EK, Zobell S, Gaddis K, Rollins MD. Most children experience resolution of idiopathic pediatric rectal prolapse with bowel management alone. J Pediatr Surg 2022; 57:354-358. [PMID: 34872729 DOI: 10.1016/j.jpedsurg.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/24/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies in children with idiopathic rectal prolapse report up to 48% require surgical intervention to manage refractory disease. We sought to examine outcomes of our non-surgical approach to managing rectal prolapse using a bowel management program. METHODS A retrospective review was performed for all children with the diagnosis of rectal prolapse between 2011 and 2020. Children with a rectal polyp or hemorrhoid were excluded. RESULTS 47 children with rectal prolapse were identified (median age at diagnosis of 4 years (IQR 3,7.75); age ≤ 4 years n = 30; age > 4 years n = 17). Associated diagnoses included constipation (n = 45, 96%) and psychiatric diagnoses (n = 7, 14%). Children underwent a bowel management program including stimulant laxatives in 44 (94%) and osmotic laxatives in 2 (4%). Median follow-up time was 181 days (IQR 77, 238). Median time to resolution of rectal prolapse was 9 months (IQR 4, 13) with a maximum time to resolution of 31 months. We compared children ≤ 4 years old (Group A) to those > 4 years old (Group B). Psychiatric diagnoses were less common in Group A (3.5 vs. 38.9%, p = 0.003). Median time to spontaneous resolution was 6.5 months (IQR 3.5, 9.5) in Group A versus 13.5 (IQR 4, 16) months in Group B, p = 0.13. No differences in surgical intervention were identified. Three (6.4%) patients required surgery for prolapse. CONCLUSIONS A bowel management program is an effective treatment for most children with rectal prolapse. This data suggests that surgical intervention is unnecessary in most children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Scott S Short
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States.
| | - Elisabeth K Wynne
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
| | - Sarah Zobell
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
| | - Katherine Gaddis
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
| | - Michael D Rollins
- Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
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Sajankila N, DeRoss A, Lipman JM. Approach to the Adult Colorectal Patient with a History of Pediatric Abdominal Surgery. Clin Colon Rectal Surg 2022; 35:177-186. [PMID: 35966376 PMCID: PMC9374533 DOI: 10.1055/s-0042-1742412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Children with colorectal diseases often undergo operative management in their youth. As these patients become adult, it is important for surgeons to understand their postoperative anatomy as well as the pathophysiology of their diseases. Here, we present a description of common colorectal diseases of childhood that may have significant impact on patients' presentations as adult. We also discuss the diagnosis and management of conditions that are usually seen early in life but may present during adulthood as well.
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Affiliation(s)
- Nitin Sajankila
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anthony DeRoss
- Department of Pediatric General Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M. Lipman
- Department of Colorectal Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
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Mustafa G, Asad A, tul Muntaha S. Comparison of 5% Phenol With Almond Oil Versus 15% Hypertonic Saline in Treatment of Pediatric Idiopathic Rectal Prolapse. Cureus 2022; 14:e23552. [PMID: 35399434 PMCID: PMC8986137 DOI: 10.7759/cureus.23552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 12/01/2022] Open
Abstract
Objective: The objective of the study was to compare the frequency of recurrence with 5% phenol in almond oil versus 15% hypertonic saline for pediatric idiopathic rectal prolapse. Methodology: An open-label, randomized clinical trial was conducted at the Department of Paediatric Surgery, Services Hospital, Lahore, Pakistan, over a period of one year from May 1, 2018 to April 30, 2019. Altogether, 120 patients with idiopathic rectal prolapse were included in this study. After obtaining approval from the hospital ethical committee, all patients fulfilling the inclusion criteria were admitted to the pediatric surgery inpatient department of Services Hospital, Lahore. Patients were randomized into two groups with an equal number of candidates using the lottery method. Group A consisted of patients who were administered 5% phenol in almond oil and group B consisted of patients who were administered 15% hypertonic saline. All procedures were performed by a single surgical operating team to control bias. Patients were followed up for three months after surgery to note whether recurrence occurred or not. Results: The mean age of the patients was 3.97 ± 2.68 years in group A and 2.87 ± 1.84 years in group B. Gender distribution showed male dominance (71.7% in group A and 73.3% in group B). Statistically significant difference was observed in terms of recurrence (50% in group A and 23.3% in group B) (p=0.002), while statistically insignificant differences were found in terms of postoperative faecal incontinence (2% in each group, p=0.6478) and anal stenosis (8% in group A and 2% in group B with p=0.2426). Conclusion: Thus, 15% hypertonic saline was noted to be a more effective sclerosing agent than 5% phenol in almond oil in the management of idiopathic rectal prolapse in children. It was also found to have a statistically comparable rate of complications, including fecal incontinence and anal stenosis.
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Benign anorectal disease in children: What do we know? Arch Pediatr 2022; 29:171-176. [DOI: 10.1016/j.arcped.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/31/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022]
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Zhou W, Shi Y, Zhang M, Li L. The Remission Effects of First Injection of Sclerotherapy for Pediatric Rectal Prolapse: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:835235. [PMID: 35284492 PMCID: PMC8907260 DOI: 10.3389/fsurg.2022.835235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/14/2022] Open
Abstract
Background Pediatric rectal prolapse is a common issue in clinical practice. Among various managements, sclerotherapy is an important method to successfully treat pediatric rectal prolapse, especially for the first injection. The knowledge of the first injection of sclerotherapy can be revealed by a systemic review and meta-analysis of randomized clinical trials. Methods We performed a systematic search and a meta-analysis for the retrospective clinical studies of sclerotherapy in pediatric rectal prolapse. The comparison between remission and recurrence after the first injection of sclerotherapy was performed to find if the first injection of sclerotherapy can treat rectal prolapse completely. After a restricted selection, 17 studies involving 1,091 pediatric rectal prolapse subjects with sclerotherapy were enrolled in a variety of classifications of injection agents. The focused outcome was to check whether the first injection of sclerotherapy can achieve a remission status. The meta-analysis was performed by Review Manager 5.4. Results Among the subjects receiving sclerotherapy, the meta-analysis favors the remission status after receiving the first injection of sclerotherapy. The meta-analysis results showed significant remission tests for the overall effect and significant heterogeneities in odds ratio and the fixed-effects model. The significant therapeutic effects remained, however, even after testing in the relative risk and the random-effects model. Conclusions Despite significant heterogeneity and relatively low quality of evidence, the first injection of sclerotherapy may conceivably demonstrate therapeutic effects to help the patients of pediatric rectal prolapse achieve a remission status.
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Affiliation(s)
- Weimo Zhou
- Department of Pediatric Surgery, Guigang City People's Hospital, Eighth Affiliated Hospital of Guangxi Medical University, Guigang, China
| | - Yingzuo Shi
- Department of Pediatric Surgery, Wuxi People's Hospital, Wuxi, China
| | - Ming Zhang
- Clinical Laboratory, Zhucheng Maternal and Child Health Hospital, Zhucheng, China
| | - Li Li
- The Department of Pediatrics, Ganzhou People's Hospital, Ganzhou, China
- *Correspondence: Li Li
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Shen B. Endoscopic band ligation with hypertonic glucose cushion in the treatment of ileal pouch prolapse. Gastroenterol Rep (Oxf) 2021; 9:480-482. [PMID: 34733536 PMCID: PMC8560034 DOI: 10.1093/gastro/goaa089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/22/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- Bo Shen
- Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
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Reddington H, Figueroa A, Cohen A, Castro R, Payne C, Lotakis D, Wallack M, Friedman D, Cooper A. Rectal prolapse and abdominal compartment syndrome: Formerly unknown complications of hernia repair in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Saadai P, Trappey AF, Langer JL. Surgical Management of Rectal Prolapse in Infants and Children. Eur J Pediatr Surg 2020; 30:401-405. [PMID: 32920799 DOI: 10.1055/s-0040-1716725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The surgical management of children with rectal prolapse is wide ranging and without consensus within the pediatric surgical community. While the majority of rectal prolapse in infants and children resolves spontaneously or with the medical management of constipation, a small but significant subset of patients may require intervention for persistent symptoms. In this review, we discuss the etiology and pathophysiology of rectal prolapse in both infants and children, options for medical management, described interventions and surgical options and their outcomes, and future avenues for research and investigation.
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Affiliation(s)
- Payam Saadai
- Department of Pediatric Surgery, UC Davis Children's Hospital, Sacramento, California, United States.,Department of Pediatric Surgery, Shriners Hospitals for Children Northern California, Sacramento, California, United States
| | - A Francois Trappey
- Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, United States
| | - Jacob L Langer
- Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Laparoscopic Suture versus Mesh Rectopexy for the Treatment of Persistent Complete Rectal Prolapse in Children: A Comparative Randomized Study. Minim Invasive Surg 2020; 2020:3057528. [PMID: 32411460 PMCID: PMC7204089 DOI: 10.1155/2020/3057528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 05/06/2019] [Accepted: 07/08/2019] [Indexed: 01/31/2023] Open
Abstract
Purpose To compare laparoscopic mesh rectopexy with laparoscopic suture rectopexy. Patients and Methods. The prospective study was conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between Feb 2010 and Jan 2015. Seventy-eight children with persistent complete rectal prolapse were subjected to laparoscopic rectopexy. Fourteen parents refused to participate. All patients received initial conservative treatment for more than one year. The remaining 64 patients were randomized divided into two equal groups. Group A; 32 patients underwent laparoscopic mesh rectopexy and group B, 32 underwent laparoscopic suture rectopexy. The operative time, recurrence rate, post-operative constipation, and effect on fecal incontinence, were reported and evaluated for each group. Results Sixty-four cases presented with persistent complete rectal prolapse were the material of this study. They were 40 males and 24 females. Mean age at operation was 8 (5–12) years. All cases were completed laparoscopically. Mean operative time in laparoscopic suture rectopexy was shorter than laparoscopic mesh rectopexy group. No early post-operative complications were encountered. No cases of recurrence with mesh rectopexy group while in suture rectopexy group it was 4 cases (14.2%). Post-operative constipation occurred in one case (3.57%) in suture rectopexy group and occurred in one case (3.3%) in mesh rectopexy group. Fecal incontinence improved in 26/28 cases (92.8%) in suture rectopexy while in mesh rectopexy it was improved in 30/30 cases (100%) of cases. Conclusion Both laparoscopic mesh and suture rectopexy are feasible and reliable methods for the treatment of complete rectal prolapse in children. However, no recurrence, low incidence of constipation and high improvement of incontinence at follow up more than 36 months with mesh rectopexy accordingly, we considered mesh rectopexy to be the procedure of choice in treatment of complete rectal prolapse.
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Trappey AF, Galganski L, Saadai P, Stephenson J, Stark R, Farmer DL, Langer JC, Hirose S. Surgical management of pediatric rectal prolapse: A survey of the American Pediatric Surgical Association (APSA). J Pediatr Surg 2019; 54:2149-2154. [PMID: 30987759 DOI: 10.1016/j.jpedsurg.2019.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/19/2019] [Accepted: 02/17/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many management options exist for the treatment of refractory rectal prolapse (RP) in children. Our goal was to characterize current practice patterns among active members of APSA. METHODS A 23-item questionnaire assessed the management of full-thickness RP for healthy children who have failed medical management. The survey was approved by our IRB and by the APSA Outcomes committee. RESULTS 236 surgeons participated. The respondents were geographically dispersed (44 states, 5 provinces). 32% of respondents had twenty or more years of clinical experience. 71% evaluated 1-5 RP patients in the last 2 years, while 5% evaluated >10. 71% performed 0-1 procedure (operation or local therapy [LT]) for RP over 2 years. 59% would treat a 2-year-old patient differently than a 6-year-old with the same presentation, and were more likely to offer up-front surgery to a 6-year-old (26% vs 15%, p = 0.04), less likely to continue medical management indefinitely (2% vs 7%, p=0.01), and more likely to perform resection with rectopexy (30% vs. 15%, p=0.01). 71% perform LT as an initial intervention: injection sclerotherapy (59%), anal encirclement (8%), and sclerotherapy + anal encirclement (5%). 70% consider LT a failure after 1-3 attempts. If LT fails, surgical management consists of transabdominal rectopexy (46%), perineal proctectomy or proctosigmoidectomy (22%), transabdominal sigmoidectomy + rectopexy (22%), and posterior sagittal rectopexy (9%). CONCLUSIONS There is wide variability in the surgical management of pediatric rectal prolapse. This suggests a need for development of processes to identify best practices and optimize outcomes for this condition.
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Affiliation(s)
- Alfred Francois Trappey
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, David Grant Medical Center, Travis AFB, CA, 2425 Stockton Blvd., Sacramento, CA 25817.
| | - Laura Galganski
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Payam Saadai
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Jacob Stephenson
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, David Grant Medical Center, Travis AFB, CA, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Rebecca Stark
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Diana L Farmer
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Jacob C Langer
- Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Shinjiro Hirose
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
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Shehata SM, Elhaddad AA, Abo Senna WM, Shehat MA. Laparoscopic Posterolateral Suture Rectopexy for Recurrent Rectal Prolapse in Children. J Laparoendosc Adv Surg Tech A 2019; 29:1292-1296. [PMID: 31545119 DOI: 10.1089/lap.2019.0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: Laparoscopic rectopexy for recurrent rectal prolapse (RP) is more widely used nowadays. Strict indications are needed to get proper outcomes. The advantages rely on the careful dissection of peritoneal sac and fixation of rectum. One of the theories of recurrent RP is hernia-like physiology in front of the rectum. Purpose: The aim of this study is to present our experience of posterolateral laparoscopic suture rectopexy (LSR) in indicated children of recurrent RP. Patients and Methods: Sixteen patients were included with recurrent RP wherein all were subjected to LSR procedure after exclusion of other probable causes. Dissection of peritoneal sac anterior to the rectum was carried out followed by closure of the deep pouch by nonabsorbable sutures then fixation of the right side of rectum and sigmoid to the lateral wall of areolar tissue. Fixation to sacral promontory is done by Ethibond or Prolene sutures when redundancy is obvious. Results: The study included 11 girls and 5 boys with age ranging between 3 and 12 years in the past 5 years. Ten cases were treated earlier with injection therapy and 6 following Thiersh procedure after failure of conservative treatment for 6 months. Operative time ranged between 40 and 100 minutes. Follow-up period ranged between 6 and 36 months with mean of 19.5 months. Postoperative mucosal prolapse reported in 1 case 6 months postsurgery with no full thickness recurrence. Conclusions: LSR is an efficient technique in well-selected children of recurrent RP and could reverse this underlying pathology. Longer follow-up and evidence are needed to standardize the technique.
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Affiliation(s)
- Sherif M Shehata
- Section of Pediatric Surgery, Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed A Elhaddad
- Section of Pediatric Surgery, Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Wael M Abo Senna
- Section of Pediatric Surgery, Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed A Shehat
- Section of Pediatric Surgery, Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Morrison ZD, LaPlant M, Hess D, Segura B, Saltzman D. A systematic review of management options in pediatric rectal prolapse. J Pediatr Surg 2019; 54:1782-1787. [PMID: 30905414 DOI: 10.1016/j.jpedsurg.2019.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/23/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Rectal prolapse is a relatively common condition in infants and young children with a multifactorial etiology. Despite its prevalence, there remains clinical equipoise with respect to secondary treatment in pediatric surgery literature. We conducted a systematic review to evaluate methods of secondary treatment currently used to treat rectal prolapse in children. METHODS We searched Pubmed, Medline, and Scopus with the terms "rectal prolapse" and "children" for papers published from 1990 to April 2017. Papers satisfying strict criteria were analyzed for patient demographics, intervention, efficacy, and complications. Procedures were grouped by like type. Pooled success rates were calculated. RESULTS Twenty-seven studies documenting 907 patients were included. Injection sclerotherapy had an overall initial success rate of 79.5%. Ethyl alcohol seemed the best sclerosing agent due to a high first-injection success rate, low complication rate, and ready accessibility. Several perineal repairs were found, with operative success rates ranging from 60.8%-100%. Laparoscopic rectopexy with mesh was the most commonly reported transabdominal procedure and had an overall success rate of 96.1%. Postoperative complications from all procedures were comparable. CONCLUSION Though many secondary treatment options have been reported for rectal prolapse, sclerotherapy and laparoscopic rectopexy predominate in contemporary literature and appear to have high success and low complication rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zachary D Morrison
- Marshfield Medical Center, Department of Surgery, 1000 N. Oak Ave., Marshfield, WI 54449, USA.
| | - Melanie LaPlant
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
| | - Donavon Hess
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
| | - Bradley Segura
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
| | - Daniel Saltzman
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
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Hintz GC, Zou VZ, Baird R. Sclerotherapy for rectal prolapse in children: A systematic review and meta-analysis. J Pediatr Surg 2019; 54:1083-1088. [PMID: 30782440 DOI: 10.1016/j.jpedsurg.2019.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sclerotherapy is a commonly utilized treatment for rectal prolapse in children. This study systematically evaluates the effectiveness and complications of various sclerosing agents in treating pediatric rectal prolapse. METHODS After protocol registration (CRD-42018088980), multiple databases were searched. Studies describing injection sclerotherapy for treatment of pediatric rectal prolapse were included, with screening and data abstraction duplicated. The methodological quality of included papers was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS Nineteen studies were identified, published between 1970 and 2017. Most studies were single institution case series, with median "N" 57+/-88.9 and mean MINORS score of 0.51+/-0.17 (perfect score = 1). 1510 patients with a mean age of 4.5 years were accounted for: 36.2% female, most without comorbidities. Mean follow up length was 30 months. The most common sclerosing agent described was ethanol (45%), followed by phenol (33%). The mean number of treatments per patient was 1.1+/-0.34. The overall success rate after a single sclerotherapy treatment was 76.9%+/-8.8%. The overall complication rate was 14.4%+/-2%. CONCLUSIONS Injection sclerotherapy appears effective and low-risk in the treatment of pediatric rectal prolapse and should be considered before more invasive surgical options. The available evidence is of relatively poor quality, and prospective comparative investigations are warranted. LEVEL OF EVIDENCE 3 (meta-analysis of level 3 studies).
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Affiliation(s)
- Graeme Charles Hintz
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada; Division of General Surgery, Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Vito Zhaoxin Zou
- MD Undergraduate Program, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Robert Baird
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada.
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De la Torre L, Zornoza-Moreno M, Cogley K, Calisto JL, Wehrli LA, Ruiz-Montañez A, Santos-Jasso K. Transanal endorectal approach for the treatment of idiopathic rectal prolapse in children: Experience with the modified Delorme's procedure. J Pediatr Surg 2019; 54:857-861. [PMID: 30381137 DOI: 10.1016/j.jpedsurg.2018.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Persistent or recurrent idiopathic rectal prolapse in children requires surgical intervention. Several techniques have been used to repair this problem. However, recurrence and complications continue to be a challenge in the management of this condition. Here we report our experience in using the modified Delorme's procedure to treat such patients. METHODS We conducted a retrospective observational study of patients with idiopathic rectal prolapse who underwent the modified Delorme's procedure during 2013-2017. We analyzed the clinical characteristics of the patients and the recurrence and complication rates during a follow-up of 15-68 months. RESULTS We included 14 patients. The age at operation ranged from 2 to 17 years, and the length of the prolapse was 3-15 cm. There were no intraoperative or postoperative complications. All patients achieved postoperative fecal control, and there were no recurrences. CONCLUSION The modified Delorme's procedure was effective for the treatment of idiopathic rectal prolapse. There were no recurrences or complications. Because it is a perineal technique, the procedure avoids the risk of nerve injury that exists for transabdominal methods.
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Affiliation(s)
- Luis De la Torre
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - María Zornoza-Moreno
- Centro Colorrectal para Niños de México y Latinoamérica, Hospital Angeles Puebla, Puebla, Mexico..
| | - Kimberly Cogley
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - Juan L Calisto
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - Lea A Wehrli
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - Alejandro Ruiz-Montañez
- Centro Colorrectal para Niños de México y Latinoamérica, Hospital Angeles Puebla, Puebla, Mexico..
| | - Karla Santos-Jasso
- Department of Pediatric Surgery, Instituto Nacional de Pediatría, Ciudad de México, Mexico..
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Meshram GG, Kaur N, Hura KS. Complete Rectal Prolapse in Children: Case Report, Review of Literature, and Latest Trends in Management. Open Access Maced J Med Sci 2018; 6:1694-1696. [PMID: 30337991 PMCID: PMC6182530 DOI: 10.3889/oamjms.2018.376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: Complete rectal prolapse is the circumferential descent of all the layers of the rectum through the anus. It often leads to bleeding, obstructed defecation, incarceration or fecal incontinence. CASE REPORT: We present a rare case of a 4-year-old child with complete rectal prolapse of 12 cm in length. The prolapsed rectum was manually repositioned after reducing the oedema. The precipitating factor was identified as excessive straining while passing stools. A change in position while passing stools was advised along with a high fibre diet and a stool softener. Recurrence was not observed in the 3 month of follow-up. CONCLUSION: Most cases of pediatric rectal prolapse are managed conservatively by addressing the associated and precipitating etiological factors. Surgical intervention may be required for recurrent or persistent cases.
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Affiliation(s)
- Girish Gulab Meshram
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Kaur
- Department of Radiology, University of Texas Health Science Centre, San Antonio, Texas, USA
| | - Kanwaljeet Singh Hura
- Department of Paediatrics, Richmond University Medical Centre, Staten Island, New York, USA
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Abstract
Rectal prolapse is a common and self-limiting condition in infancy and early childhood. Most cases respond to conservative management. Patients younger than 4 years with an associated condition have a better prognosis. Patients older than 4 years require surgery more often than younger children. Multiple operative and procedural approaches to rectal prolapse exist with variable recurrence rates and without a clearly superior operation. These include sclerotherapy, Thiersch's anal cerclage, Ekehorn's rectopexy, laparoscopic suture rectopexy, and posterior sagittal rectopexy.
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Affiliation(s)
- Rebecca M Rentea
- Deparment of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D St Peter
- Deparment of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Albertsdottir E, Qvist N. Postoperative complications and long-term functional outcome in children operated for idiopathic rectal prolapse. Pediatr Surg Int 2018; 34:85-89. [PMID: 29119251 DOI: 10.1007/s00383-017-4208-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the postoperative complications and the long-term gastrointestinal functional outcome after surgical treatment for rectal prolapse on a strategy with stapled anopexy for short (< 5 cm) prolapse and Delormes procedure for longer (> 5 cm) rectal prolapse. METHODS A total of 38 patients were included with a postoperative follow-up period ranging from 1 month to 9.1 years. Thirty patients (83%) completed the Rome III questionnaire on gastrointestinal function, with the follow-up period ranging from 2 months to 7 years. RESULTS Thirty-five patients were treated with stapled anopexy as a primary surgical treatment. One minor complication with slight postoperative bleeding was observed, but the recurrence rate was 34.3%. Treatment of recurrence with re-stapling gave success rate of 44.4%. Ten patients (3 primary and 7 with recurrence after stapled anopexy) were treated with Delormes procedure with no observed complications or recurrence. Four out of nineteen patients treated with stapled anopexy fulfilled the criteria for functional gastrointestinal symptoms and in 3 out of 8 treated with Delormes procedure. No patients reported continence problems. CONCLUSION The recurrence rate for stapled anopexy was high and none with Delormes procedure. The functional outcome was comparable with a healthy population of children.
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Affiliation(s)
| | - Niels Qvist
- Surgical Department A, Odense University Hospital, Odense, Denmark.
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Elhaddad A, Amerstorfer EE, Singer G, Huber-Zeyringer A, Till H. Laparoscopic posterior rectopexy (Well's procedure) for full-thickness rectal prolapse following laparoscopic repair of an anorectal malformation: A case report. Int J Surg Case Rep 2017; 42:187-190. [PMID: 29268123 PMCID: PMC5737946 DOI: 10.1016/j.ijscr.2017.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/10/2017] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic repair of intermediate anorectal malformation (ARM) lead to full-thickness rectal prolapse (RP) in a boy. As conservative treatment modalities failed, the parents opted for surgical treatment at the patient’s age of 4 years. Intractable RP of 2 cm with ulcerations was successfully treated by Well’s laparoscopic posterior mesh-rectopexy. The mid-term outcome was favorable with no prolapse recurrence. Well’s procedure represents a feasible treatment option for RP secondary to ARM repair in children.
Introduction Intractable full-thickness rectal prolapse (IRP) unresponsive to conservative treatment remains a major problem after anorectoplasty for high or intermediate anorectal malformation (ARM). Surgical management must aim for a permanent fixation of the rectum to the presacral fascia. While in children with IRP following ARM repair the optimal procedure has not been established yet, laparoscopic posterior mesh-rectopexy (Well’s procedure) has demonstrated efficacy in adults. Presentation of case A male infant with intermediate ARM received laparoscopic-assisted anorectal pull-through at the age of 4 months. Three months later he developed mucosal prolapse and received multimodal conservative treatment. Because of progression into a full-thickness RP with ulcerations, the parents opted for surgical management. Well’s procedure was performed at the age of 4 years. Using four ports, the rectum was circumferentially mobilized down to the pelvic floor and pulled inside. A 5 × 5 cm prolene mesh was tacked to the sacrum, enveloped posteriorly 270° around the rectum, fixed with interrupted prolene sutures on both edges and carefully covered with peritoneum. Any redundant external mucosa was excised from a perineal approach. There were no intra- and postoperative complications. Within 1.5 years of follow-up the boy had voluntary bowel movements and was toilet trained. No prolapse recurrence could be observed nor provoked. Discussion We present the first pediatric case of IRP secondary to laparoscopic ARM repair which has been successfully treated by combined Well’s procedure and perineal mucosal resection. Conclusion Well’s procedure is a successful technique and should be further explored in children with ARM and IRP.
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Affiliation(s)
- Ahmed Elhaddad
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Eva E Amerstorfer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Andrea Huber-Zeyringer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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Dolejs SC, Sheplock J, Vandewalle RJ, Landman MP, Rescorla FJ. Sclerotherapy for the management of rectal prolapse in children. J Pediatr Surg 2017; 53:S0022-3468(17)30637-1. [PMID: 29103788 DOI: 10.1016/j.jpedsurg.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Rectal prolapse is a commonly occurring and usually self-limited process in children. Surgical management is indicated for failures of conservative management. However, the optimal approach is unknown. The purpose of this study is to determine the efficacy of sclerotherapy for the management of rectal prolapse. METHODS This was a retrospective review of children <18years with rectal prolapse who underwent sclerotherapy, predominantly with peanut oil (91%), between 1998 and 2015. Patients with imperforate anus or cloaca abnormalities, Hirschprung disease, or prior pull-through procedures were excluded. RESULTS Fifty-seven patients were included with a median age of 4.9years (interquartile range (IQR) 3.2-9.2) and median follow-up of 52months (IQR 8-91). Twenty patients (n=20/57; 35%) recurred at a median of 1.6months (IQR 0.8-3.6). Only 3 patients experienced recurrence after 4months. Nine of the patients who recurred (n=9/20; 45%) were re-treated with sclerotherapy. This was successful in 5 patients (n=5/9; 56%). Two patients (n=2/20; 10%) experienced a mucosal recurrence which resolved with conservative management. Forty-four patients were thus cured with sclerotherapy alone (n=44/57; 77%). No patients undergoing sclerotherapy had an adverse event. Thirteen patients (n=13/20; 65%) underwent rectopexy after failing at least one treatment of sclerotherapy. Three of these patients (n=3/13; 23%) recurred following rectopexy and required an additional operation. CONCLUSIONS Injection sclerotherapy for children with rectal prolapse resulted in a durable cure of prolapse in most children. Patients who recur following sclerotherapy tend to recur within 4months. Another attempt at sclerotherapy following recurrence is reasonable and was successful half of the time. Sclerotherapy should be the preferred initial treatment for rectal prolapse in children and for the initial treatment of recurrence. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Treatment Study.
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Affiliation(s)
- Scott C Dolejs
- Indiana University School of Medicine, Division of Pediatric Surgery
| | - Justin Sheplock
- Indiana University School of Medicine, Division of Pediatric Surgery
| | | | - Mathew P Landman
- Indiana University School of Medicine, Division of Pediatric Surgery
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Aoki Y, Kitazawa K. A case of paediatric rectal prolapse without spontaneous reduction on arrival. BMJ Case Rep 2017; 2017:bcr-2017-220608. [DOI: 10.1136/bcr-2017-220608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rahman AA, Robinson AM, Brookes SJH, Eri R, Nurgali K. Rectal prolapse in Winnie mice with spontaneous chronic colitis: changes in intrinsic and extrinsic innervation of the rectum. Cell Tissue Res 2016; 366:285-299. [DOI: 10.1007/s00441-016-2465-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/29/2016] [Indexed: 12/19/2022]
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Sumida W, Kaneko K, Ono Y, Takasu H. A new type of defecation disorder due to insufficient fixation of the rectum to the sacrum is improved by rectopexy: A report of three cases. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Bequet E, Stiennon L, Lhomme A, Piette C, Hoyoux C, Rausin L, Guidi O. [Rectal prolapse revealing a tumor: The role of abdominal ultrasound]. Arch Pediatr 2016; 23:723-6. [PMID: 27265581 DOI: 10.1016/j.arcped.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 04/09/2016] [Indexed: 11/20/2022]
Abstract
Rectal prolapse is rare in children and usually benign. However, there are various diseases that can be associated with it, such as cystic fibrosis or other causes of increased abdominal pressure. Here, we review the various underlying conditions that pediatricians or pediatric gastroenterologists should consider in the case of rectal prolapse. We report on three cases of children with a rectal prolapse and intra-abdominal tumors. Current recommendations and practice do not include a systematic check via abdominal imaging in cases of rectal prolapse. However, in some situations, imaging is indicated to detect a possible expansive process. Thus, in the presence of recurrent prolapse or of associated urinary or neurological signs, imaging is justified so as to allow for an early diagnosis and treatment of these neoplasms. Given its lack of radiation exposure and good sensitivity in children, ultrasound imaging is the first choice.
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Affiliation(s)
- E Bequet
- Service universitaire de pédiatrie, CHR de la Citadelle, boulevard du Douzième-de-Ligne 1, 4000 Liège, Belgique; Service universitaire de pédiatrie, CHU de Liège, avenue de l'Hôpital, 1, 4000 Liège, Belgique.
| | - L Stiennon
- Service universitaire de pédiatrie, CHR de la Citadelle, boulevard du Douzième-de-Ligne 1, 4000 Liège, Belgique
| | - A Lhomme
- Service universitaire de pédiatrie, CHR de la Citadelle, boulevard du Douzième-de-Ligne 1, 4000 Liège, Belgique
| | - C Piette
- Service universitaire de pédiatrie, CHR de la Citadelle, boulevard du Douzième-de-Ligne 1, 4000 Liège, Belgique
| | - C Hoyoux
- Service universitaire de pédiatrie, CHR de la Citadelle, boulevard du Douzième-de-Ligne 1, 4000 Liège, Belgique
| | - L Rausin
- Service d'imagerie médicale, CHR de la Citadelle, boulevard du Douzième-de-Ligne 1, 4000 Liège Belgique
| | - O Guidi
- Service universitaire de pédiatrie, CHR de la Citadelle, boulevard du Douzième-de-Ligne 1, 4000 Liège, Belgique
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Abstract
Rectal prolapse is a herniation of the rectum through the anus. It is rare in children. When it does occur, it is usually prior to 4 years of age and due to anatomical variants. A few conditions predispose children to rectal prolapse, the most common being constipation. Cystic fibrosis used to be commonly associated with rectal prolapse, but with the advent of cystic fibrosis newborn screening, this association is no longer as frequently seen. Many recent case reports, detailed in this chapter, describe conditions previously unknown to be associated with rectal prolapse. Management is usually supportive; however, rectal prolapse requires surgical management in certain situations. This review details the presentation of rectal prolapse, newly described clinical manifestations, and associated conditions, and up-to-date medical and surgical management.
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Affiliation(s)
- Kristen Cares
- Department of Pediatric Gastroenterology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
| | - Mohammad El-Baba
- Department of Pediatric Gastroenterology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
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Chauhan K, Gan RWC, Singh S. Successful treatment of recurrent rectal prolapse using three Thiersch sutures in children. BMJ Case Rep 2015; 2015:bcr-2015-211947. [PMID: 26607187 DOI: 10.1136/bcr-2015-211947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Many techniques are described to manage recurrent rectal prolapse in children, including repeated Thiersch stitch, phenol injections, Delorme and Altemeier procedures, and rectopexy. We describe a case of successful treatment of rectal prolapse by placing three Thiersch sutures circumferentially along the anal canal--a simple and novel modification of a well-known procedure. An 8-year-old boy with full-thickness rectal prolapse was treated with laxatives to no avail. He was subsequently treated with phenol-in-almond-oil injection and insertion of a 1/0PDS Thiersch suture. The effects were temporary with recurrence 3 months later. A further phenol-in-almond-oil injection was given and a 1/0PDS Thiersch suture placed, and the patient was discharged on laxatives. Recurrence occurred again at 3 months. This was treated with three circumferential Thiersch sutures along the anal canal--one Prolene 2/0 and two 1/0PDS. There has been no recurrence at follow-up. Placement of three sequential Thiersch sutures along the rectum is effective in treating recurrent rectal prolapse and a good alternative to major rectopexy.
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Affiliation(s)
- Kashif Chauhan
- Department of Paediatric Surgery, Queen's Medical Campus, Nottingham, UK
| | | | - Shailinder Singh
- Department of Paediatric Surgery, Queen's Medical Campus, Nottingham, UK
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Rectal prolapse in children: a study of 71 cases. GASTROENTEROLOGY REVIEW 2015; 10:105-7. [PMID: 26557942 PMCID: PMC4631274 DOI: 10.5114/pg.2015.49003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/17/2014] [Accepted: 10/23/2014] [Indexed: 11/28/2022]
Abstract
Introduction Prolapse of the rectum is the herniation of the rectum through the anus, which may be categorised as mucosal or complete. Aim To evaluate the clinical manifestation, treatment, and surgical complications of children with rectal prolapse over a 6-year period. Material and methods This study was carried out on children aged < 14 years who were admitted or referred for rectal prolapse that failed to respond after medical treatment in Imam Khomeini and Abouzar Children's Hospital. Duration of the study was 6 years starting in March 2002. These cases were referred after failure of medical and conservative treatment. Age, sex, clinical manifestation, and type of procedure were recorded. Analysis was done using SPSS version 11.0 (SPSS Inc, Chicago, IL, USA). The χ2 test was used for comparison. Results Seventy-one cases were included in this study. Of these cases, 50 (70.4%) were male and 21 (29.6%) were female (p < 0.0001). Mean age of cases was 4.97 ±3.42 years (range: 2 days to 13 years). Of the male cases, 38% were in the age range of 3–6 years. In female cases, 57.1% were in the range of 1.5–3 years. Of all 71 cases, injection sclerotherapy was done for 50 (70.43%) for the first time. Twenty-one cases had history of injection sclerotherapy and 16 (22.53%) were treated by perineal surgery, and 5 (7.04%) had abdominal surgery. One case experienced recurrent rectal prolapse (1.40%) following injection sclerotherapy. Conclusions In girls, more than half of the cases were in the age range 1.5–3 years. Among male cases, 38% were in the age range of 1.5–3 years. The results of treatment of rectal prolapse in our hospitals was similar to that seen in developed countries.
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Hill SR, Ehrlich PF, Felt B, Dore-Stites D, Erickson K, Teitelbaum DH. Rectal prolapse in older children associated with behavioral and psychiatric disorders. Pediatr Surg Int 2015; 31:719-24. [PMID: 26163086 DOI: 10.1007/s00383-015-3733-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Rectal prolapse (RP) beyond infancy is challenging, and despite surgical correction, recurrences are not uncommon, suggesting that underlying contributing processes may have a role. This study highlights a previously poorly recognized relationship between RP in older children and behavioral/psychiatric disorders (BPD). We describe the incidence of recurrence and use of behavioral, psychological and physical therapeutic tactics in a multidisciplinary approach to pediatric RP. METHODS A retrospective 20-year review of RP in children >3 years of age was adopted. Charts were reviewed for gastrointestinal, connective tissue, and BPD conditions, incidence of recurrence, and therapies employed including surgery, behavioral, and physical therapy. RESULTS 45 patients were included, ranging from 3 to 18 years of age; 29 males. Thirty-seven underwent surgery. Six of the 45 were excluded as they had gastrointestinal or connective tissue conditions placing them at risk for prolapse. Over half (21/39, 53%) had BPD. Slightly more than half of patients had a recurrence, but there was no increased risk in those with associated BPD. While all 21 underwent some therapy for their BPD, over the past 5 years we have enrolled eight of these patients into a program of behavioral and/or physical therapy with all reporting reductions in frequency and severity of prolapse after initiating pelvic floor strengthening, behavior modification, and biofeedback, and avoidance of surgery in three. CONCLUSIONS This study highlights an important group of pediatric patients with RP that may well benefit from a combination of behavioral therapy, physical therapy as well as surgical intervention to obtain the most optimal outcome.
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Affiliation(s)
- Shelley Reynolds Hill
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA
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Tashiro J, Burnweit CA. Rectal prolapse unreduced for 4 months in a premature neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2013.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ezer SS, Kayaselçuk F, Oguzkurt P, Temiz A, Ince E, Hicsonmez A. Comparative effects of different sclerosing agents used to treat rectal prolapse: an experimental study in rats. J Pediatr Surg 2013; 48:1738-43. [PMID: 23932615 DOI: 10.1016/j.jpedsurg.2012.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Sclerosing agents injected into the rectal submucosal area produce an inflammatory response and scar that prevent rectal prolapse. This study aimed to investigate the histopathological changes following submucosal injection of different sclerosing agents in rats. METHODS Rats (n=35) were divided into control, sham, and five experimental groups, each treated with a different sclerosing agent: cow's milk, 30% saline solution, 30% dextrose solution, 70% ethyl alcohol, and 5% phenol in almond oil (PAO). All agents were injected into the submucosal area. After 4 weeks, all animals were sacrificed. Histopathological evaluation was performed according to a semi-quantitative fibrosis scoring system (grades 0 to 3), by using Masson trichrome and hematoxylin and eosin staining. RESULTS Histopathological changes in the 5% phenol in almond oil group were significantly different from other groups (p=0.0001). Prominent submucosal fibrosis (grade 3), lymphatic vascular dilation, foreign body reaction, and lipogranuloma were observed in the 5% PAO group (p=0.007). No significant histopathological differences were seen between the 30% saline, 30% dextrose, and 70% ethyl alcohol groups. Significantly increased mucosal fibroblast proliferation (grade 2) was seen in 60% rats of the 30% dextrose group (p=0.026). The cow's milk and ethyl alcohol groups had mucosal erosions and congestion (grade 1) which were significantly different from the control group (p=0.024). No statically significant difference was observed between the 30% saline group and the control group. CONCLUSIONS In this study we showed that 5% PAO can induce some histopathological changes in the submucosal area that increase the mucosal tightness of the mucosa, which are necessary for the treatment of rectal prolapse.
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Affiliation(s)
- Semire Serin Ezer
- Başkent University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
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Campbell AM, Murphy J, Charlesworth PB, Bhan C, Jarvi K, Power N, Ward HC, Williams NS. Dynamic MRI (dMRI) as a guide to therapy in children and adolescents with persistent full thickness rectal prolapse: a single centre review. J Pediatr Surg 2013; 48:607-13. [PMID: 23480920 DOI: 10.1016/j.jpedsurg.2012.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/22/2012] [Accepted: 08/02/2012] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Full thickness rectal prolapse (FTRP) tends to be self-limiting in children and is usually managed expectantly. However, it may persist and therefore requires surgical correction. There is no consensus upon operative management, and no one procedure has uniformly good outcomes. The aim of this study was to determine whether pre-operative diagnostic dMRI findings might help identify the operative approach best suited to the anatomical abnormality of the individual child. METHODS A retrospective review of ten children with persistent FTRP who had been evaluated pre-operatively with dMRI between 2002 and 2010 was performed. In this preliminary work, MRI findings were not used to direct surgical management. Data collected included: age at presentation, underlying medical conditions, timing and findings of dMRI (specifically, descent of rectum from pubococcygeal (PC) line on straining), timing and type of surgery, surgical outcomes, and length of follow-up. RESULTS Ten children (two female) with a median age of 11 years 2 months (range 8-15 years) with FTRP refractory to conservative treatment underwent diagnostic pre-operative dMRI. Median perineal descent from PC line on straining during dMRI was 3.5 cm (range 1-4 cm). Three of the seven children with severe descent initially underwent a Delorme's procedure, and all required surgical revision. Five with severe descent and one with moderate descent achieved a cure following rectopexy. Two patients with mild descent underwent a Delorme's procedure. One achieved a cure, and the other developed recurrence. Of the ten patients, seven had no prolapse at the last clinic review, and three have persisting symptoms. Median follow-up was 3.5 years (range 1-6). CONCLUSION The findings from this small study favour rectal suspension techniques for surgical management of moderate to severe perineal descent on dMRI. Delorme's procedure should only be applied to those with mild descent. Pre-operative dMRI assessment may have a potential role in guiding surgical intervention for children. However, future prospective studies will be required to confirm this assertion.
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Koivusalo AI, Pakarinen MP, Rintala RI, Seuri R, Buchen G, Kenmoti VT. Dynamic defecography in the diagnosis of paediatric rectal prolapse and related disorders. Pediatr Surg Int 2012; 28:815-20. [PMID: 22806602 DOI: 10.1007/s00383-012-3125-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Paediatric rectal prolapse (RP) is rarely a diagnostic problem and resolves often spontaneously. We studied whether the assessment of recurrent RP (RP), postoperative relapsed RP (RRP) or anorectal discomfort without RP (ARD) benefits from dynamic defecography (DD) and describe DD findings in relation with outcome. PATIENTS AND METHODS Fifteen patients (7 males), median age of 10 (range 3.7-15) years, underwent 19 DD with a synchronic small bowel contrast study. Indications for DD were RP (n = 11), RD (n = 3) and RRP (n = 1). Three patients had solitary rectal ulcer and one juvenile rectal polyps (n = 1). Three patients underwent a total of four postoperative DD because of suspected relapse. RESULTS In 11 patients with a clinically diagnosed prolapse DD displayed a simple prolapse (n = 3), prolapse with enterocele (n = 1), prolapse with small bowel interposition (n = 1), rectal intussusception with anterior rectocele (n = 1) and rectal intussusception (n = 1) and no pathology (n = 4) (37 %). In four patients with ARD DD displayed rectal prolapse originating from sigmoid intussusception (n = 1), enterocele (n = 1) and anterior rectocele (n = 1) and no pathology in one. Median follow-up was 8.1(range 3.0-44) months. Ten patients underwent surgery. Three patients with RP underwent simple laparoscopic rectopexy, five with RP or RD with enterocele or anterior rectocele had rectopexy with anterior peritoneoplasty and two (RP n = 1, RRP n = 1) with sigmoid intussusception had sigmoid resection with rectopexy. Two symptomatic patients (RP, negative DD) are scheduled for rectopexy. Three patients PPRP (n = 2) RD (n = 1) had spontaneous cure. Postoperative DD confirmed relapsed RP in one patient. CONCLUSION In patients, RP and associated disorders' DD can disclose significant pathology (enterocele, rectocele or sigmoid intussusception) and thereby guide surgical treatment, and should be included in the pre-treatment assessment.
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Affiliation(s)
- A I Koivusalo
- Children's Hospital, University of Helsinki, Stenbackinkatu 11, 00290, LNS HUS PL 281, Finland.
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Philip AT, Marraffa JM. Death following injection sclerotherapy due to phenol toxicity. J Forensic Sci 2012; 57:1372-5. [PMID: 22827471 DOI: 10.1111/j.1556-4029.2012.02224.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 04/18/2011] [Accepted: 05/01/2011] [Indexed: 11/30/2022]
Abstract
Prolapse rectum (PR) or protrusion of the rectum beyond the anus occurs frequently in populations at both extremes of age. In the pediatric population, in developed countries, the commonest cause for PR is thought to be cystic fibrosis (CF). Treatment options for CF include conservative management, surgical resection and fixation, suturing, and injection sclerotherapy (IS). The last is considered an attractive treatment option because it is minimally invasive. In this case report, the authors present the details about a 2-year-old female child, with PR and CF, who died after IS, using phenol as the sclerotherapeutic agent. Autopsy findings and toxicology tests performed to establish phenol toxicity are documented. The available literature is reviewed. This case report underscores the risks of using phenol for IS and emphasizes the point that the procedure is not innocuous and an adverse outcome including fatality is a possibility.
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Affiliation(s)
- Abraham T Philip
- Onondaga County Medical Examiner's Office, 100 Elizabeth Blackwell Street, Syracuse, NY, USA.
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Potter DD, Bruny JL, Allshouse MJ, Narkewicz MR, Soden JS, Partrick DA. Laparoscopic suture rectopexy for full-thickness anorectal prolapse in children: an effective outpatient procedure. J Pediatr Surg 2010; 45:2103-7. [PMID: 20920740 DOI: 10.1016/j.jpedsurg.2010.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 06/02/2010] [Accepted: 06/02/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Our approach to full-thickness anorectal prolapse has transitioned to laparoscopic suture rectopexy (LSRP). The purpose of this study was to describe the indications, technique, and postoperative outcomes for LSRP. METHODS Rectopexy was performed using 3 or 4 laparoscopic ports. Redundant rectum was retracted from the pelvis, and the posterior rectal wall was secured to the sacral promontory using 3 permanent sutures. RESULTS Nineteen children (7 girls) underwent LSRP from March 2003 to January 2008. Mean age was 6.2 ± 3.6 years. Three patients had prior perineal operations: 2 sacrococcygeal teratoma resections and 1 pull-through for Hirschsprung disease. One patient had cystic fibrosis, and another had Prader-Willi syndrome. The remaining children had either chronic constipation or idiopathic prolapse. All patients were treated preoperatively with laxatives. Two patients received antegrade continent enemas. Length of stay was 1 ± 0.8 days, with only the first 5 patients admitted to the hospital. The patient with Prader-Willi syndrome had a full-thickness recurrence (5%) owing to obsessive-compulsive behavior. Partial mucosal prolapse occurred in 2 patients. There were no other complications. CONCLUSIONS Laparoscopic suture rectopexy is an effective minimally invasive method to treat full-thickness rectal prolapse in children from various etiologies. It can be performed as an outpatient procedure with minimal morbidity and low recurrence rate (5%).
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Affiliation(s)
- D Dean Potter
- Division of Pediatric Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Laituri CA, Garey CL, Fraser JD, Aguayo P, Ostlie DJ, St Peter SD, Snyder CL. 15-Year experience in the treatment of rectal prolapse in children. J Pediatr Surg 2010; 45:1607-9. [PMID: 20713207 DOI: 10.1016/j.jpedsurg.2010.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/11/2010] [Accepted: 01/11/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rectal prolapse is a common and usually self-limited condition in children. Several surgical techniques have been advocated for refractory prolapse. We reviewed our experience with treatment and the outcome of refractory rectal prolapse. METHODS Retrospective review was conducted on patients undergoing surgery for rectal prolapse from January 1993 to March 2009. Patients with imperforate anus/cloacal abnormalities, Hirschsprung disease, spina bifida, or prior pull-through were excluded. RESULTS Twenty patients underwent 23 procedures for rectal prolapse. There were 10 posterior sagittal rectopexies, 6 transabdominal rectopexies, 5 laparoscopic rectopexies, 1 hypertonic saline injection, and 1 anal cerclage. The mean duration of symptoms was 1.6 years (range, 1-10 years). The mean age at operation was 6.8 years (range, 4 months-19 years), with a 5:1 male predominance. There was no operative or perioperative mortality. Median length of follow-up was 7.2 months; 2 patients were lost to follow-up. The overall recurrence rate was 35%. All recurrences followed posterior sagittal rectopexies, which had a 70% recurrence rate. Four patients required reoperation, all done transabdominally (2 open and 2 laparoscopically). None of the 3 remaining patients with mild recurrences required reoperation. CONCLUSIONS A variety of options for management of refractory rectal prolapse in children exist. Laparoscopic rectopexy seems to be safe and a comparatively successful option in these children.
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Affiliation(s)
- Carrie A Laituri
- Department of Pediatric Surgery, Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA
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Shalaby R, Ismail M, Abdelaziz M, Ibrahem R, Hefny K, Yehya A, Essa A. Laparoscopic mesh rectopexy for complete rectal prolapse in children: a new simplified technique. Pediatr Surg Int 2010; 26:807-13. [PMID: 20532893 DOI: 10.1007/s00383-010-2620-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2010] [Indexed: 01/26/2023]
Abstract
PURPOSE Rectal prolapse in children without underlying conditions is usually a self-limiting problem and requires no surgical treatment. For children with persistent rectal prolapse, a variety of surgical procedures have been described with success. Recently, there are many reports addressing the successful use of different laparoscopic approaches for complete rectal prolapse. We present a novel simplified laparoscopic technique for management of those patients. The aim of this study is to evaluate the results that can be achieved by using this technique in management of persistent complete rectal prolapse in children. METHODS We reviewed the reports of 680 patients with primary complete and partial rectal prolapse over the period from August 2000 to August 2008. Fifty-two patients with complete primary rectal prolapse refractory to medical treatment for 2 years underwent a novel simplified technique for laparoscopic mesh rectopexy. RESULTS Conservative management was successful with no recurrences in 628 patients (92.4%) while 52 (7.6%) patients did not respond to conservative management at a median follow-up period of 2 years. They were 35 males and 17 females. Their ages ranged from 2 to 14 years (mean 6). All patients were subjected to laparoscopic mesh rectopexy successfully without any conversion. The mean duration of surgery was 40 min. No intraoperative complications were reported, but one patient developed postoperative constipation that responded well to conservative treatment. The mean postoperative hospitalization was 2 days. Two cases were lost to follow-up, while the others were available for 36 months. There was no recurrence. CONCLUSION Laparoscopy mesh rectopexy is safe, rapid, effective technique. It improved functional outcome without recurrence. It is associated with minimal postoperative pain and short hospital stay with excellent cosmoses.
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Affiliation(s)
- Rafik Shalaby
- General Surgery Department, Al-Azhar University, Cairo, Egypt.
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An unusual pediatric case of chronic constipation and rectosigmoid prolapse diagnosed by video defecography. J Pediatr Surg 2010; 45:1050-2. [PMID: 20438953 DOI: 10.1016/j.jpedsurg.2010.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 03/01/2010] [Accepted: 03/01/2010] [Indexed: 11/27/2022]
Abstract
Rectal prolapse is a relatively common, benign condition in the pediatric population. Conservative management usually results in resolution of the problem. Persistent rectal prolapse with chronic constipation suggests more serious underlying pathologic condition that may be challenging to diagnose. We present a case of severe recurrent rectal prolapse with chronic constipation in a 13-year-old boy. Using video defecography, an unusual radiographic modality in children, a functional sigmoid obstruction was observed that was not found on more routine imaging studies. Laparoscopic sigmoidectomy provided an excellent outcome in this patient who previously had a lifestyle-limiting, chronic condition.
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Flum AS, Golladay ES, Teitelbaum DH. Recurrent rectal prolapse following primary surgical treatment. Pediatr Surg Int 2010; 26:427-31. [PMID: 20238206 PMCID: PMC2862483 DOI: 10.1007/s00383-010-2565-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE The management of recurrent rectal prolapse following initial surgical procedures remains unclear. We present a series of pediatric patients with rectal prolapse and describe their surgical management, and the subsequent care for those children developing recurrence. METHODS The records of 29 pediatric patients with rectal prolapse refractory to conservative medical management who were managed with primary modified Thiersch procedures over a 14-year period were reviewed. Initial surgical management consisted of a modified version of the Thiersch anal encirclement procedure, which involved a combination of injection sclerotherapy, linear cauterization, and placement of a Thiersch anal encirclement absorbable stitch. Age at initial procedure, predisposing conditions, complications, recurrence, time to recurrence, and subsequent procedures utilized were reviewed. RESULTS Of 29 patients, 22 (71%) were male with a mean age at time of first Thiersch procedure of 7.1 years (range 3 months to 19 years). Seven patients were lost to follow-up. Nineteen patients (90%) experienced resolution of their prolapse following one or two modified Thiersch procedures; 14 (67%) following an initial Thiersch and 5 (23%) following a subsequent Thiersch. One additional child experienced recurrence after an initial Thiersch procedure, and underwent a perineal resection of redundant rectum (modified Altemeier procedure). Two patients developed a recurrence after their second Thiersch. These cases both required a modified Altemeier procedure. Mean follow-up for all patients was 1.5 years. CONCLUSION For pediatric rectal prolapse refractory to conservative medical therapy, the modified Thiersch procedure appears reasonable. Initial recurrences are not uncommon, and their incidence increases with the age of the child. Recurrences should be initially managed by a repeat Thiersch procedure. However, subsequent recurrences should be treated with a modified Altemeier.
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Affiliation(s)
- Andrew S Flum
- Section of Pediatric Surgery, CS Mott Children's Hospital, University of Michigan, Mott F3970, Box 5245, Ann Arbor, MI 48109, USA
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Abdominal posterior rectopexy with an omental pedicle for intractable rectal prolapse: a modified technique. Pediatr Surg Int 2009; 25:719-22. [PMID: 19554335 DOI: 10.1007/s00383-009-2404-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Rectal prolapse is a relatively common paediatric surgical condition. It has a number of benign aetiologies. Management is usually centred on regulating bowel habits. Surgery is considered after the failure of medical treatment. Numerous surgical techniques have been described with a spectrum of results. MATERIALS AND METHODS We adopted a limited abdominal approach to achieve a posterior rectopexy using an omental pedicle in intractable cases. This technique has not been performed in children previously. RESULTS From 2005 to 2008 we have applied this technique on five patients with recurrent rectal prolapse which had failed to respond to medical treatment, injection sclerotherapy or perianal cercalage. One patient had solitary rectal ulcer syndrome, and was initially treated with a defunctioning colostomy, had a concomitant sigmoidectomy performed at the time of rectopexy. None of the patients had cystic fibrosis. There were three females and two males, with a mean age of 9.6 years (4.7-14.0). No operative complications were encountered. The mean hospital stay was 5.4 days (3-8). None of the patients experienced recurrence at a mean of 2.1 years (0.2-2.8) follow up. The cosmetic result was regarded as satisfactory by all patients. CONCLUSION This early experience with abdominal posterior rectopexy using an omental pedicle graft is encouraging. This technique does not involve the use of synthetic material and hence the risk of infection is low.
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Affiliation(s)
- James S Wu
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Mayfield Heights, Ohio, USA
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Ratan SK, Rattan KN, Jhajhria P, Mathur YP, Jhanwar A, Kondal D. The surged faradic stimulation to the pelvic floor muscles as an adjunct to the medical management in children with rectal prolapse. BMC Pediatr 2009; 9:44. [PMID: 19602234 PMCID: PMC2715404 DOI: 10.1186/1471-2431-9-44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 07/14/2009] [Indexed: 11/22/2022] Open
Abstract
Background To assess the role of the surged faradic stimulation to the pelvic floor muscles as an adjunct to the conservative management in the children of idiopathic rectal prolapse Methods Study design: Prospective Setting: Pediatric Surgery Department, Pt BD Sharma, Post Graduate Institute of Medical Sciences, Rohtak Subjects: 47 consecutive children with idiopathic rectal prolapse attending the Pediatric Surgery out patient department from July 2005 to June 2006 Methodology: The information pertaining to duration and the extent of rectal prolapse, predisposing or associated medical conditions, results of local clinical examination were noted. Surged faradic stimulation using modified intraluminal rectal probe, was given on the alternate days. The conventional conservative medical management was also continued. The extent of relief and the number of the sittings of faradic stimulation required were noted at various stages of follow-ups Statistical Methods: Mean values between those completely cured and others; poor responders and others were compared with t-test and proportions were compared with Chi square test. The p-value < 0.05 was considered statistically significant. Results The mean number of sittings in the completely cured group (n = 28(64%)) was (12.4 ± 7.8) and was comparable with very poor responder (n = 6(13%). There was higher percentage of relief (76%) at the first follow up (at 15 days) in completely cured Vs other (37%) and also the poor responders showed (20%) Vs other (68%) and was statistically significant. Conclusion With use of faradic stimulation, even the long-standing rectal prolapse can be fully cured. The follow up visit at 2 weeks is very important to gauge the likely success of this modality in treatment of the patients with rectal prolapse. Those showing poor response at this stage may require alternative treatment or take a long time to get cured
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
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Intussusception mimicking rectal prolapse. Pediatr Radiol 2008; 38:700-2. [PMID: 18327576 DOI: 10.1007/s00247-008-0782-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 01/17/2008] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
Abstract
We report a 10-week-old boy with a prolapsing colocolic intussusception mimicking rectal prolapse. Rectal prolapse of ileocolic intussusception has been well-described, but colocolic intussusception presenting as rectal prolapse is unique.
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Zganjer M, Cizmic A, Cigit I, Zupancic B, Bumci I, Popovic L, Kljenak A. Treatment of rectal prolapse in children with cow milk injection sclerotherapy: 30-year experience. World J Gastroenterol 2008; 14:737-40. [PMID: 18205264 PMCID: PMC2684001 DOI: 10.3748/wjg.14.737] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the role and our experience of injection sclerotherapy with cow milk in the treatment of rectal prolapse in children.
METHODS: In the last 30 years (1976-2006) we made 100 injections of sclerotherapy with cow milk in 86 children. In this study we included children who failed to respond to conservative treatment and we perform operative treatment.
RESULTS: In our study we included 86 children and in all of the patients we perform cow milk injection sclerotherapy. In 95.3% (82 children) of patients sclerotherapy was successful. In 4 (4.7%) patients we had recurrent rectal prolapse where we performed operative treatment. Below 4 years we had 62 children (72%) and 24 older children (28%). In children who needed operative treatment we performed Thiersch operation and without any complications.
CONCLUSION: Injection sclerotherapy with cow milk for treatment rectal prolapse in children is a simple and effective treatment for rectal prolapse with minimal complications.
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Lee JI, Vogel AM, Suchar AM, Glynn L, Statter MB, Liu DC. Sequential Linear Stapling Technique for Perineal Resection of Intractable Pediatric Rectal Prolapse. Am Surg 2006. [DOI: 10.1177/000313480607201212] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rectal prolapse (RP), although most frequently encountered in the frail elderly, may also occur in children. This condition is most troublesome in the premature infant with significant associated comorbidities. Pediatric RP most often can be managed conservatively with expectant and/or judicious use of laxative-based bowel regimens. In rare instances of intractable RP, surgical intervention ranging from simple (sclerotherapy, Thiersch wire) to complex (perineal or trans-abdominal bowel resection) becomes necessary. We describe a modification of the Altemeier technique using a novel sequential linear stapling technique to treat intractable RP in a 5.0-kg infant with severe coexisting life-threatening comorbidities. The child had resumption of bowel movements on postoperative Day 1 and has had no recurrences. Sequential linear stapling technique for perineal resection of intractable pediatric RP appears to be a safe and potentially attractive alternative.
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Affiliation(s)
- Jong In Lee
- Department of General Surgery, Kwandong University, Myongji Hospital, College of Medicine, Deokyang-Gu, Goyang, Gyeonggi, Korea and
| | - Adam M. Vogel
- Division of Pediatric Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois
| | - Adam M. Suchar
- Division of Pediatric Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois
| | - Loretto Glynn
- Division of Pediatric Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois
| | - Mindy B. Statter
- Division of Pediatric Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois
| | - Donald C. Liu
- Division of Pediatric Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois
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