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Rectal Prolapse in Children

Myung Duk Lee, M.D., Won Woo Kim, M.D.

Department of Surgery, Pediatric Surgery, Kangnam St. Mary's Hospital, Catholic University Medical College

Seoul, Korea

Because rectal prolapse in pediatric age was known to have a self - limitting natural history in weeks to years, this disease is prone to be regarded as a minor codition to the most of surgeons. But to the children and the parents who have to be suffered each time could be a heavy distress. Even though operative or nonoperative methods can be applicable for treatment, the main problem is in surgeon's side, whose preference is based on the experiences of adult patients. The authors have experienced 16 cases of ano - rectal prolapse for 9 years since 1986. Eleven of them were true rectal prolapses. In 7 cases of true type, injec­tion therapy has been tried. One ml of five per cent phenol in glycerine was in­jected into the submucosal layer of the ano- rectal angle level at both lateral and posterior sides. After first trial of each cases, 5 of them were cured com­pletely so far. Recurrences were in two cases, but one of them was temporary to be subsided afterward. Complete bowel cleansing and adequate sedations were required as preoperative preparations. Two days' oral antibiotics and two weeks' laxatives for free of defecation straining were recommended after the procedure. The safety of sclerosis was supported by the experimental histology. In pediatric rectal prolapse, sclerosis seems to be a safe and effective treatement of choice without any significant morbidity.

Index Words: Prolapse, Rectum, Sclerosis, Children

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Table 1. Classification of Anorectal Prolapses

Type

Complete rectal prolapse

Anal mucosal prolapse

Preprolapse

Total

No. of cases

11

4

1 16

Fig. 1. Photograph of true rectal prolapse, a four-year-old girl.

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Fig. 2. Injection sclerosis procedure. Insert the index finger of operator's left hand into the anal cannal to guide the direction of needle into the submucosa of the rectum.

Table 2. Summary of Sclerosis Procedure

1. Bowel preparation.

2. Sedation or anesthesia

3. Clean drapping & position

4. Insert left index into anal cannal

5. Needle into rectal submucosa around the

level of anorectal angle

6. Injection 1 ml of 5 % phenol in glycerin

at 3,6 & 9 o'clock directions.

7. Medication after operation:

Oral antibiotics for 2 days.

MgO for 2 weeks.

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Table 3. Prepositional Conditions

Prepositions

Constipation

Enteritis

Patulous anus

Imperforate anus, postop.

Intussusception*

No. of cases

3

Pelvic trauma -.~~--~--.--~~----~---­*; intussusception through the anus.

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Table 4. Case Summary of Rectal Prolapse

Case Age/ Sex Duration Tx Result

1. lO/ F l yr SE*

2. 14/ F 2yr S Cure

3. 13/F l yr S Cure

4. 3!F 6m S Recur

5. 16/F

6. 14/ F

7. 15/ F

8. 3/ F

9. 5/ F

10. 4/ F

11. 6/ F

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3yr

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5yr S Cure

3m

2m S Cure

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Table 5. Result of Sclerotherapy in Rectal Pro·

lapse

Result

Cure

Cure with temporary recur

Recur

Total

No. of Cases

5

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Fig. 4. Photomicrograph of rat intestine 2 weeks after sclerosis, showing marked submucosal fibro· sis with minimal inflammatory cells infilteration (HE staining, x 40). Increased wrinkling of muco­sal folds looks more compacted in the lumen. There was no evidence of necrosis of mucosa, nor of muscularis.

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1. Willie GG : The injection treatment of

rectal prolapse. J Pediatr Surg 14: 62-

64, 1979

2. Theuerkauf F J Jr, Beahrs OH, Hill JR:

Rectal prolapse: Causation and surgical

treatment. Ann Surg 171: 819-835, 1970

3. Leape LL: Other disorders of the rectum

and anus; Rectal prolapse, in Welch KJ,

Randolph JG et al( eds) : Pediatric Sur­

gery( ed 4). YearBook, Chicago, 1986,

Ppl042-1043

4. Kay NRM, Zachary RB: The treatment

of rectal prolapse in children with injec­

tion of 30 percent saline solutions. J

Pediatr Surg 5:334-337, 1970

5. Millard DR, Rowe MI : Plastic surgical

principles in high imperforate anus. Plast

Reconstr Surg 69: 399-411, 1982

6. Caouette-Laberge L, Yazbeck S, Laberge

JM, Ducharme ']C: Multiple-flap anoplas­

ty in the treatment of rectal prolapse

after pull-through operations for imper­

f orate anus. J Pediatr Surg 22: 65-67,

1987

7. de Vries PA: Results of treatment and

their assessment, in Stephens FD, Smith

ED. Alan R(eds): Anorectal malforma­

tions in children: update 1988. Alan R

Liss Inc., NY, 1988, Pp481-500

8. Ripstein CB: Surgical care of maSSlve

rectal prolapse. Dis Colon Rect 8: 34-,

1965

- 139 -

9. Ripstein CB, Lanter B: Etiology and sur­

gical therapy of massive prolapse of the

rectum. Ann Surg 157:259-264, 1963

10. Palmer JA: The management of massive

rectal prolapse. Surg Gynecol Obstet :

502-506, 1961

11. Corman ML: Rectal Prolapse, in Colon

& Rectal Surgery(ed 3). JB Lippincott,

Philadelphia, 1993, Pp293-336

12. Ashcraft KW, Amoury RA, Holder TM:

Levator repair and posterior suspension

for rectal prolapse. J Pediatr Surg 12:

241-245, 1977