A rectal prolapse is when one or all layers of the rectal mucosa protrude out through the anal opening (FIGURE 32.1).
Complete prolapse occurs when all layers of the rectum protrude through the anal opening
Incomplete prolapse refers to an internal prolapse that does not project through the anal opening and does not need an emergent reduction
Mucosal prolapse is the protrusion of only the rectal mucosa externally
CONTRAINDICATIONS
The following conditions require an emergent surgical consultation:
Irreducible complete prolapse
Strangulation or gangrene of the rectal tissue
Perforation or rupture of the rectal tissue
Anal incontinence
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
A thick muscle layer palpable between the thumb and forefinger suggests a complete prolapse. This will present with the folds in a concentric ring pattern.
In a mucosal prolapse, the mucosal folds originate from the central lumen of the protrusion and extend outward in a radial manner
Mucosal prolapses tend to extend not beyond 4 cm from the anus, whereas complete prolapses may extend up to 15 cm from the anal verge
General Basic Steps
Patient preparation
Prolapse reduction
Postreduction care
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