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Rectal Injuries and Prolapse: Causes, Symptoms, and Treatments

Learn about rectal injuries and prolapse, including causes like falls and childbirth, symptoms, and treatments such as local repair and submucous injection. Find out more about partial and complete prolapse and the treatments for infants, young children, and adults.

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Rectal Injuries and Prolapse: Causes, Symptoms, and Treatments

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  1. Rectal InjuriesRectal Prolapse

  2. Rectal Injuries • Causes- fall in sitting position, childbirth, sexual assault, bull gore injury • Rule out bladder , urethral injury and peritoneal injury • Treatment- EUA: local repair ?colostomy, laparotomy and repair/ resection ?colostomy

  3. Rectal Prolapse • Partial • Complete- Procidentia

  4. Partial rectal prolapse • Rectal intussusception <4 cm • 2 layers of mucous membrane • Children- 1 to 3 years most common, Undeveloped sacral curve, poor sphincter tone, diarrhoea, whooping cough, malnutrition, neurological disease • Adults- 3rd degree haemorrhoids, perineal tear, urinary obstruction, poor sphincter tone in elderly

  5. Treatment • Infants and young children- Digital reposition, Submucous injection of sclerosing agents( 5% phenol in almond oil) • Adults- Submucous injection, Goodsall’s ligature

  6. Complete Prolapse(Procidentia) • > 4cm length, full thickness rectal wall intussusception • Poor pelvic floor musculature and anal sphincter tone • In women often associated with uterine prolapse, previous pelvic surgery • Starts usually along the anterior wall • If >5 cm will contain peritoneum anteriorly in the wall, small intestine if larger

  7. Treatment • Perineal operations- De lorme’s operation, Thiersch wiring, Altemeir’s operation • Abdominal rectopexy- Well’s operation: mesh around the rectum which is fixed to the sacrum, by open or laparoscopy. Ripstein’s operation: teflon sling from rectum to sacrum

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