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At least 19 recordsLinked to original sources
PubMed2001

Rectal prolapse, rectal intussusception, rectocele, and solitary rectal ulcer syndrome.

Rectal prolapse can be diagnosed easily by having the patient strain as if to defecate. A laparoscopic rectopexy should be recommended. Intussusception is more an epiphenomenon than a cause of defecatory disorder and should be managed conservatively. Solitary rectal ulcer syndrome is a consequence of chronic straining, and therapy should include restoring a normal defecation habit. Rectocele should be left alone; an operation may be considered if it is larger than 3 cm and is causing profound symptoms despite maximizing medical therapy for the associated defecation disorder.

Female↗
PubMed1996

Continence is improved after the Ripstein rectopexy. Different mechanizms in rectal prolapse and rectal intussusception?

PURPOSE: This study was undertaken to evaluate anal manometric changes after Ripstein's operation for rectal prolapse and rectal intussusception and to study the clinical outcome following the operation, with special reference to anal incontinence. METHODS: Forty-two patients with rectal prolapse or rectal intussusception were subjected to anorectal manometry preoperatively and seven days and six months postoperatively. A detailed history was obtained from each patient preoperatively and six months postoperatively. RESULTS: Preoperatively, patients with rectal intussusception had higher maximum resting pressure (MRP) (52+/- 23 mmHg) than patients with rectal prolapse (34 +/- 20 mmHg; P < 0.01). In the group of patients with rectal prolapse, there was a postoperative increase in MRP after six months (P < 0.001) but not after seven days. Maximum squeeze pressure (MSP) did not increase. Neither MRP nor MSP increased postoperatively in patients with internal rectal procidentia. Continence was improved postoperatively both in patients with rectal prolapse (P < 0.01) and rectal intussusception (P < 0.01). There was no postoperative increase in rectal emptying difficulties. CONCLUSION: Ripstein's operation often improved anal continence in patients with rectal prolapse and rectal intussusception. This improvement was accompanied by increased MRP in patients with rectal prolapse, indicating recovery of internal anal sphincter function. No postoperative increase in MRP was found in patinets with rectal intussusception. This suggests an alternate mechanism of improvement in patients with rectal intussusception.

Adult↗
PubMed2000

[Rectal prolapse].

Rectal prolapse and rectal intussuception correspond to two stages of the same disease. Rectal prolapse is unusual but requires surgical treatment. Abdominal rectopexy is the most effective procedure but increases the risk of postoperative constipation. This risk decreases when the lateral sides are not touched during rectal dissection. The Delorme procedure is associated with a higher rate of recurrence and must be reserved for patients presenting a high risk of postoperative complications. Rectal intussuception is more frequent and is pathological only when arising in the anal sphincter. Rectal intussuception may lead to solitary rectal ulcer and has in this case to be treated by rectopexy. Rectal intussuception involvement in terminal constipation is not yet proved. Internal mucosectomy seems to be the best treatment for terminal constipation.

Anus Diseases↗
PubMed1997

The best operation for rectal prolapse.

Rectal prolapse remains a disorder for which the cause is not clearly understood and the best method of management is debated. Because the natural history of prolapse frequently leads to complications of incontinence and constipation, we believe that all patients presenting with internal and external prolapse should be considered for repair. Although the type of operative repair recommended may vary, it is clear that all patients with external rectal prolapse should be offered some type of repair. What is not clear from the literature is the appropriate management of those patients with internal prolapse. As shown in the George Washington University experience, surgery is rarely performed for isolated internal prolapse. Most patients who present with internal prolapse also have an associated enterocele, rectocele, or cystocele. Repair of the internal prolapse and the associated disorder may benefit many of these patients. If internal prolapse is an isolated finding, it is not clear to what extent the prolapse is responsible for the patient's symptoms, and repair is generally not advised. These guidelines are easy to enumerate but may be difficult to practice in some patients. Therefore, ongoing evaluation of clinical results is critical to improve our understanding of these disorders. This discussion has outlined the current theories of the cause of rectal prolapse, the symptoms and findings patients present with, and the possible approaches to repair.

Colorectal Surgery↗
PubMed1985

Rectal prolapse.

Rectal prolapse occurs mostly in the geriatric female patient and can be a very disabling condition. The etiology is intussusception of the rectosigmoid secondary to excessive and prolonged straining. Medical therapy for this disease process is not helpful and patients will require a surgical procedure. The two best surgical procedures for the correction of rectal prolapse are low anterior resection of the rectosigmoid and proctopexy. A few patients who are unfit for laparotomy may require the Thiersch Wire procedure. Two unresolved problems after surgical therapy are continuing constipation and incontinence. Constipation is treated by dietary measures, stool softeners, and periodic enemas. Laxatives are to be discouraged. Incontinence in patients with rectal prolapse improves in most patients after a procedure to correct the prolapse. In those patients in which incontinence persists, no form of therapy has been found to be uniformly successful.

Adult↗
PubMed1990

Ruptured rectal prolapse.

Rectal prolapse is not a common surgical disorder. The complication reported here, of evisceration of small bowel through a prolapsed rectum, is extremely rare and is the first case reported in the West Indies. Some of the features of rectal prolapse are described, and the surgical management of this particular complication is discussed.

Aged↗
PubMed1997

[Rectal prolapse].

Rectal prolapse is the transposition of the entire rectal wall into the rectal lumen, the anal canal or through the anal canal out side. It differs from anal prolapse in thickness, circular plication of the mucosa and, if large, its extent. The cause is not clearly established, but disorders in bowel movement seem to be of importance. Symptoms reach from the feeling of incomplete evacuation to defecation block and irreducible prolapse. The diagnosis of outer prolapse is easy. The inner prolapse [intussusception] can be suspected by anamnesis and in the presence of solitary rectal ulcer. Defecography gives the conclusive examination. Conservative therapy is analogous to hemorrhoids: Fibres and sufficient liquid intake. Operative procedures can be divided in transabdominal and perineal procedures. From the latter Delorme's procedure gives good results with low stress for the patient. Of the transabdominal procedures we favor rectopexy with Ivalon-sponge, preservation of the lateral bands and sigmoid resection. This procedure can easily be done by laparoscopy. Postoperative constipation is observed above all if the lateral bands are dissected and no sigmoid resection is done. Preexistent constipation Improves in about 50% of the cases. Same does incontinence.

Colonic Diseases↗
PubMed1992

[E. Delorme correction of rectal prolapse].

Rectal prolapse is a distressing condition. Among the multiple corrections described, the perineal approach has generally been abandoned. However, Delorme's procedure is a good, simple and efficient intervention with a low morbidity for certain elderly selected patients. The purpose of this paper is to recall the details of this technique and review its results.

Aged↗
PubMed2001

What role does full rectal mobilization alone play in the treatment of rectal prolapse?

Rectal mobilization is a component of many operations for the treatment of rectal prolapse. How much of the successful treatment of this condition is due to this procedure alone has not been previously investigated. Full posterior rectal mobilization was done alone without sigmoid resection or rectopexy in thirteen patients. Of the thirteen patients with a mean follow-up of 33.4 months, there have been one early and one late recurrence. One further patient had a anterior mucosal prolapse at 1 year. Ten patients remain recurrence-free. In conclusion, rectal mobilization alone gives results close to more extensive operations and may be the major component of their success. In addition it may have less risk of sepsis.

Adolescent↗
PubMed1995

Laparoscopic Treatment of Rectal Prolapse.

Rectal prolapse is a distressing condition often affecting elderly patients. Open rectopexy has a proven track record in the treatment of this condition but may be complicated by significant morbidity. The benign nature of the disease and reduced pain and pulmonary complications of the laparoscopic approach makes this an attractive operation in this patient group. Laparoscopic prosthesis fixation rectopexy and lateral ligament suspension with and without colectomy have been described with low recurrence rates, good patient acceptance, improvement in symptoms, and both radiological and physiological assessments, although these initial findings require further evaluation with prospective controlled trials.

Journal Article↗
PubMed1981

[Management of rectal prolapse by rectal mobilization and fixation with Ivalon sponge].

Follow-up is reported in 34 patients with rectal prolapse treated at the Department of Surgery, Aarau, in the period 1972-1980 by mobilization of the rectum and fixation with Ivalon Sponge. The follow-up showed that the method has a low complication rate and a low recurrence rate (2 minor recurrences). Noteworthy is the good restoration of continence. Prior to surgery, 60% of the patients were also incontinent for solid stool. In the follow-up, all the patients were continent for normal stool and half for liquid stool. Despite the advanced age of some of the patients, postoperative mortality was nil.

Fecal Incontinence↗
PubMed1998

Rectal prolapse and rectal invagination.

Solitary rectal ulcer, internal rectal intussusception, and complete rectal prolapse are a range of defaecatory disorders that may have a common aetiology, namely chronic straining. If the pelvic floor is weak, external prolapse is often complicated by faecal incontinence. Few patients, a lack of randomised trials, and difficulties in the interpretation of studies of anorectal physiology (the results of which often seem conflicting) have made the understanding of these disorders difficult. The basis for treatment is clear, however--patients who have symptomatic defaecatory disorders associated with an internal intussusception, or solitary rectal ulcer, or both should have a course of training of pelvic floor muscles, dietary advice, and should use fibre supplements as primary treatment. Operation should be reserved for those patients in whom medical treatment has failed, and it may be expected to relieve symptoms in above two thirds of patients. Defaecating proctography may be useful in assessing which patients may not benefit from operation. Operation is the primary treatment for external prolapse. The choice of surgical approach should be tailored according to the expertise available, the medical condition of the patient, and the presence or absence of pre-existing constipation or incontinence.

Fecal Incontinence↗
PubMed1979

[Rectal prolapse. Clinical studies on rectal prolapse].

A series of 164 patients with procidentia recti has been studied. Symptoms are sensation of obstruction, difficulties in emptying the bowel, proctitis, incontinence, reduced tonus of anal sphincters, and complete rectal prolapse. During I the rectum prolapses only under increased intraabdominal pressure and retracts spontaneously. Massive prolapse (stage II) often occurs without increased intraabdominal pressure and has to be reposited manually. Best results are obtained by fixing the mobilised rectum in the hollow of the sacrum as described by Wells in 1959 or by Ripstein in 1969. In bad risk patients a sublevatoric wire can be used. Most patients have satisfactory continence postoperatively without a corresponding physiological tonus of anal sphincters.

Adult↗
PubMed1989

A common pathophysiology for full thickness rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer.

Anorectal pressures at rest, during conscious contraction of the external sphincter, during serial distension of the rectum and during straining to inflate a balloon were measured in 56 patients (21 patients with full thickness rectal prolapse, 24 patients with anterior mucosal prolapse, 11 patients with solitary rectal ulcer) and in 30 normal subjects. Both basal and squeeze pressures were significantly lower in the three groups of patients compared with matched normal controls (P less than 0.05). During increases in intra-abdominal pressure, anal pressure remained above maximum rectal pressure (P less than 0.05) in normal controls, with the highest anal pressures being recorded in the most caudal anal channels. In contrast, anal pressures tended to be lower than rectal pressures during this manoeuvre in patients with rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer, and the highest pressures were recorded in the channels nearest the rectum. During serial distension of the rectum, 64 per cent of patients with solitary rectal ulcer, 75 per cent with anterior mucosal prolapse and 76 per cent with rectal prolapse, but only 10 per cent of controls, showed repetitive rectal contractions. The highest anal pressure always remained higher than rectal pressure during rectal distension in normal subjects (P less than 0.05) but not in patients. The threshold rectal volume required to cause a desire to defaecate and the maximum tolerable volume were significantly lower (P less than 0.05) in each of the patient groups, compared with normal subjects. The similarity in the results from patients with rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer support the hypothesis that they share a common pathophysiology. In each of the groups, the rectum is hypersensitive and hyper-reactive, and weakness of the anal sphincter creates the conditions for prolapse of the rectum to occur into or through the anal canal.

Adult↗
PubMed1998

Uterovaginal prolapse associated with rectal prolapse.

A case of combined genital prolapse and rectal prolapse in a 55-year-old multipara is reported. The mixed prolapse was treated by vaginal hysterectomy with pelvic floor repair and laparoscopic rectopexy at the same sitting. The feasibility of combined treatment of genital prolapse by the vaginal route and of rectal prolapse by laparoscopic rectopexy is emphasized.

Feasibility Studies↗
PubMed1986

The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome.

Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.

Adult↗
PubMed1990

'Diamond-shaped' crypts and mucosal elastin: helpful diagnostic features in biopsies of rectal prolapse.

The biopsy diagnosis of prolapsing rectal mucosa syndrome can be difficult. We present two newly described features--'diamond-shaped' crypts and mucosal elastin--which appear to be helpful in histological diagnosis. Of 32 biopsies of prolapsing rectal mucosa syndrome, all showed diamond-shaped crypts or mucosal elastin, and 28 contained both. Control biopsies comprised cases of normal or irritable bowel syndrome (46), irradiation colitis and ischaemic colitis (16), inflammatory bowel disease (26), and adenomas (30). Mucosal elastin and 'diamond-shaped' crypts with distinctive scalloped edges, which were never seen in prolapse, were observed in half the cases of irradiation and ischaemic colitis. Diamond-shaped crypts were seen in one case of inflammatory bowel disease. Diamond-shaped crypts and elastin were seen in the base of adenomas large enough to cause localized prolapse, and in four biopsies from patients with irritable bowel syndrome, all of whom had given a history of straining at stool.

Adenoma↗