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Rectal Injuries Rectal Prolapse

Rectal Injuries Rectal Prolapse. 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. Rectal Prolapse.

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Rectal Injuries Rectal Prolapse

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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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