Surgical and Radiologic Anatomy

, Volume 27, Issue 5, pp 414–419 | Cite as

Digital assessment of lower rectum fixity in rectal prolapse (DALR): a simple clinical anatomical test to determine the most suitable approach (abdominal versus perineal) for repair

  • Deya Marzouk
  • Michael J RamdassEmail author
  • Amyn Haji
  • Mansoor Akhtar
Anatomic Bases of Medical, Radiological and Surgical Techniques


Selection of an appropriate approach to treat full thickness rectal prolapse remains problematic and controversial. We propose that rectal prolapse may be classified as ‘low type‘ (true rectal prolapse) or ‘high type’ (intussusception of the sigmoid with a fixed lower rectum). This assessment can be made via a simple clinical test of digital rectal assessment of lower rectal fixity (‘the hook test’) based on anatomic changes in rectal prolapse to guide the selection process. In cases with the low-type prolapse, a perineal approach is appropriate (either Delorme’s procedure, or rectosigmoidectomy with or without pelvic floor repair). For the high type, an abdominal rectopexy with or without high anterior resection is needed. Retrospective analysis of our cases treated over the last 6 years showed a recurrence rate of 6% in perineal procedures and 0% in abdominal rectopexy combined with resection to date. We believe that employing our simple test and classification can contribute to better patient selection for either approach, minimize anaesthetic and surgical risks and also result in lower recurrence rates.


Rectal prolapse Digital rectal assessment 



We hereby express our sincere gratitude and appreciation to the Medical Illustration Department of East Kent Trust, Kent, England, United Kingdom, for their support and expertise in creating the illustrations.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Deya Marzouk
    • 1
  • Michael J Ramdass
    • 2
    Email author
  • Amyn Haji
    • 1
  • Mansoor Akhtar
    • 1
  1. 1.Department of Colorectal SurgeryQueen Elizabeth HospitalMargate, KentEngland
  2. 2.Department of Vascular SurgerySt. George’s Hospital, 4th Floor, St. James WingLondonUK

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