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Lars Påhlman Dept. Surgery, Colorectal unit, University Hospital, Uppsala, Sweden

Rectal Prolapse. Lars Påhlman Dept. Surgery, Colorectal unit, University Hospital, Uppsala, Sweden. Case 1. 25 year old woman > 2 years with constipation. 2 months history of full-thickness prolapse. Only at defecation. What type of examinations ?.

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Lars Påhlman Dept. Surgery, Colorectal unit, University Hospital, Uppsala, Sweden

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  1. Rectal Prolapse Lars Påhlman Dept. Surgery, Colorectal unit, University Hospital, Uppsala, Sweden

  2. Case 1

  3. 25 year old woman > 2 years with constipation. 2 months history of full-thickness prolapse. Only at defecation. What type of examinations ? Rectal prolapse - Case 1

  4. Check the colon ? Anal manomatry ? Defecography ? Anal ultrasound ? What type of operation ? Rectal prolapse - Case 1

  5. Abdominal procedure What type of rectopexy ? Sigmoid colon ? Rectal prolapse - Case 1

  6. Case 2

  7. 84 year old woman Several years history with a full-thickness prolapse. Does not disappear after defecation. What type of examinations ? Rectal prolapse - Case 2

  8. Check the colon ? Anal manomatry ? Defecography ? Anal ultrasound ? What type of operation ? Rectal prolapse - Case 2

  9. Perineal approach Delorme or Altemeier ? Rectal prolapse - Case 2

  10. Case 3

  11. 33 year old man No constipation. 6 months history of full- thickness prolapse. Only at defecation. What type of examinations ? Rectal prolapse - Case 3

  12. Check the colon ? Anal manomatry ? Defecography ? Anal ultrasound ? What type of operation ? Rectal prolapse - Case 3

  13. Case 4

  14. 54 year old woman No real constipation, but some outlet disorders and slight IBS - problems. What type of examinations ? Rectal prolapse - Case 4

  15. Check the colon ? Anal manomatry ? Defecography ? Anal ultrasound ? Rectal prolapse - Case 4

  16. Rectoscopy disclosed a solitary ulcer ? Defecography could showed an intussusception? Anal ultrasound normal sphincters ? What type of operation ? Rectal prolapse - Case 4

  17. STARR procedure ? Biofeedback ? Abdominal approach ? Rectal prolapse - Case 4

  18. Mucosal prolapse 3rd degree internal haemorrhoids ectropion - sphincteric defects following anorectal surgery atony and relaxation of both sphincters in elderly Rectal prolapse

  19. Aetiology (children) absence of sacral curve giving a vertical straight tube diminution in the amount of supporting fat and tissues in the ischiorectal fossae Rectal prolapse

  20. Aetiology (adults) Sliding hernia (Moschowitz) a sliding hernia with the whole pouch of Douglas anterior rectal wall is pressed into the rectal lumen Rectal prolapse

  21. Aetiology (adults) Intussusception (Brodén and Snellman) a circumferential intussusception starts 6 - 8 cm from the anal verge appex passes into lower rectum Rectal prolapse

  22. Aetiology (adults) Intussusception (Brodén and Snellman) after fully descended pouch of Douglas the bowel will protrude through the anus initiation of the intussusception ? Rectal prolapse

  23. Aetiology (adults) Lack of fixation (Ripstein) abnormal mobility of the rectum a consequense to rectal prolapse rather than a cause ? Rectal prolapse

  24. Aetiology (adults) Lax pelvic floor (Muir) patients with cauda equina with paralysis of the pelvic floor patients with rectal prolapse and associated incontinence Rectal prolapse

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