Prolapsse of Rectum

Dr.Dinesh.M.G
Professor of Surgery
J.J.M.M.C
Davangere

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Introduction
Rectal prolapse was known to mankind as early as 1500
B.C.
Types
Partial(Mucosal) prolapse
Complete(full-thickness) prolapse

3. Partial Prolapse
Mucosa and submucosa of rectum protrude outside anus
for approximately 1-4cms
Composed of double layer of mucous membrane
Occurs at the extremes of life
Children: 1-3 yrs
Elderly
Prolapsed mucous membrane is pink while prolapsed
haemorrhoids are plum coloured and pedunculated

4. Partial prolapse-Aetiopathology
Infants
Direct downward course of rectum due to absence of sacral curve
Diminished support of anal mucosa due to poor resting anal tone

Children
After an attack of diarrhoea
Severe whooping cough
Loss of weight resulting in reduced fat in ischiorectal fossae

5. Partial prolapse-Aetiopathology
Adults
Associated with 3
rd
degree haemorrhoids
Torn perineum in females
Straining from urethral obstruction in males
Atony of anal sphincter in old age
After an operation for fistula in ano

6. Partial prolapse in infants

7. Differential diagnosis from
intussusception

8. Treatment
In infants and children
Digital reposition and treating malnutrition
Submucous injections of phenol in almond oil
Thiersch’s operation
In adults
Submucous injections
Excision of prolapsed mucosa: Goodsall’s ligature
Endoluminal stapling

9. Thiersch’s operation

10. Goodsall’s ligature

11. Complete prolapse(procidentia)
Less common compared to partial prolapse
The protrusion is more than 4 cm in length
Involves all layers of the rectal wall
The mucosa is often arranged in a series of circular folds
Lax anal sphincter
Women are 6 times more affected and may be associated
with prolapse of uterus
Faecal incontinence

12. Complete rectal prolapse

13. Complete rectal prolapse

14. Complete rectal prolapse

15. Complete rectal prolapse

16. Complete rectal prolapse
Treatment
Abdominal approach
Preferred in most cases as it has lower recurrence rates
Open or laparoscopic
Perineal approach
Preferred in elderly and debilitated patients

17. Abdominal procedures
Mesh rectopexy
Rectum is mobilised completely
Non absorbable mesh (prolene) is fixed to presacral fascia
Mesh is partially wrapped around the rectum held up in
tension and fixed by stitches
Suture rectopexy
Resection rectopexy
Combination of anterior resection and mesh rectopexy
A good option for patients with significant constipation
Anterior resection

18. Mesh rectopexy

19. Abdominal rectopexy

20. Perineal procedures
Anal encirclement(Thiersch’s operation)
Delorme’s mucosal sleeve resection
Rectal mucosa is excised circmferentially from dentate line
to the apex of prolapse
The denuded prolapsed muscle is then pleated with a suture
The transected edges of the mucosa is sutured together
Perineal rectosigmoidectomy

21. Delorme’s operation

22. Delorme’s operation

23. Laparoscopic mesh rectopexy

24. Thank you