Management of Rectal Prolapsed in Children at ‎Medical City

Abstract

Background: Rectal prolapse is defined as circumferential descend or protrusion through the anus of one or more coats of the rectum.  Prolapse can be either partial or complete, any condition which suddenly increase  abdominal pressure may precipitate abnormal descend of bowel wall , the straining during defecation , and long periods of sitting on the toilet, allows stretching of the pelvic diaphragm and other less well-defined rectal suspensory structures which results in prolapse.

Aim : To evaluate the different type of treatment for rectal prolapse in children.

Patients & methods: This is prospective study of 80 patients of rectal prolapse was admitted  at children welfare teaching hospital at medical city, were admitted to the pediatric surgical department from January 2014 to October 2015.

Results: In our study of 80 child with rectal prolapse the age of the patient ranging from  6months to  12 year .Most common age group of presentation was (1-3) year in 43 patient  (53.7%) and main type 64 patients  (80%) was partial thickness rectal prolapse .

Most common duration of prolapse  was (1-3) months in forty patients (50.0%), all patients presented (100%)  with protruding mass and 42 patients (52.5%)  presented with incontinence .

Diarrhea was the common associated condition in 28 patients (35%),while constipation was the second associated condition in  24 patients(30%).Fifty patients (62.5%)respond to conservative treatment while 30 patients  (37.5%) patients required surgical interference .

Thirty seven patients with age less than 3 years (74%) responded to conservative treatment  and 15 patients (75%) who responded to injection sclerotherapy aged less than 3 years.

Twenty fife patients receive injection sclerotherapy , success rate after 2^nd Injection was (77%) , about (75%) of them aged less than 3 year and (70%) of them was presented with partial thickness rectal prolapsed Six  patients receive  Thiersch operation with Success Rate 66.6% , five of them with full-thickness rectal prolapse &aged more than 3 years. No mortality was conducted in this study .

Conclusion

Conservative treatment still the best treatment for rectal prolapse because it carry good chance for healing specially in children younger than 3 year. Injection sclerotherapy is the best method for treatment in patients with age less than 3 year specially in partial thickness rectal prolapse