Rectal Prolapse Reduction

A rectal prolapse is when one or all layers of the rectal mucosa protrude out through the anal opening (FIGURE 32.1).


imagesComplete prolapse occurs when all layers of the rectum protrude through the anal opening


imagesIncomplete prolapse refers to an internal prolapse that does not project through the anal opening and does not need an emergent reduction


imagesMucosal prolapse is the protrusion of only the rectal mucosa externally


CONTRAINDICATIONS



The following conditions require an emergent surgical consultation:


imagesIrreducible complete prolapse


imagesStrangulation or gangrene of the rectal tissue


imagesPerforation or rupture of the rectal tissue


imagesAnal incontinence



images


FIGURE 32.1 Anatomy of a rectal prolapse. A: Partial prolapse. B: Complete prolapse. C: Prolapsed intussusception. (From Schwartz G. Reducing a rectal prolapse. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Philadelphia, PA: Williams & Wilkins; 1997:948, with permission.)


LANDMARKS



imagesA thick muscle layer palpable between the thumb and forefinger suggests a complete prolapse. This will present with the folds in a concentric ring pattern.


imagesIn a mucosal prolapse, the mucosal folds originate from the central lumen of the protrusion and extend outward in a radial manner


imagesMucosal prolapses tend to extend not beyond 4 cm from the anus, whereas complete prolapses may extend up to 15 cm from the anal verge



imagesGeneral Basic Steps


   imagesPatient preparation


   imagesProlapse reduction


   imagesPostreduction care

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Rectal Prolapse Reduction

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