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Rectal Prolapse: An Overview of Clinical Features, Diagnosis, and Patient-Specific Management Strategies

  • Evidence-Based Current Surgical Practice
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangulation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to understand each patient’s symptoms, bowel habits, anatomy, and pre-operative expectations. Preoperative workup includes physical exam, colonoscopy, anoscopy, and, in some patients, anal manometry and defecography. With this information, a tailored surgical approach (abdominal versus perineal, minimally invasive versus open) and technique (posterior versus ventral rectopexy +/− sigmoidectomy, for example) can then be chosen. We propose an algorithm based on available outcomes data in the literature, an understanding of anorectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients.

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Disclosures

L.B., C.W.H., A.M.K., K.A., and R.S. have no disclosures. P.E.W. has no disclosures related to this work but does have a research grant from Cancer Prevention Pharmaceuticals and has served on an advisory board for Myriad Genetics.

Author information

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA

    Liliana Bordeianou

  2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, 21287, USA

    Caitlin W. Hicks

  3. Department of Colorectal Surgery, University of Southern California, Los Angeles, CA, 90033, USA

    Andreas M. Kaiser

  4. Department of Surgery, UMass Memorial Medical Center, Worcester, MA, 01605, USA

    Karim Alavi

  5. Department of Surgery, Duke University Medical Center, Durham, NC, 27710, USA

    Ranjan Sudan

  6. Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Paul E. Wise

Authors
  1. Liliana Bordeianou
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  2. Caitlin W. Hicks
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  3. Andreas M. Kaiser
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  4. Karim Alavi
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  5. Ranjan Sudan
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  6. Paul E. Wise
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Corresponding author

Correspondence to Liliana Bordeianou.

Additional information

CME Questions

1. A patient presents to clinic with an intermittent, reducible rectal mass involving only rectal mucosa that is associated with mucous discharge. Assuming internal hemorrhoids have been ruled out as the cause, he/she most likely has:

a. Complete rectal prolapse

b. Intussusception

c. Incomplete rectal prolapse

d. Enterocele

2. Most patients with rectal prolapse complain of:

a. Constipation or fecal incontinence

b. Rectal protrusion

c. Rectal bleeding or mucous drainage

d. All of the above

3. Which of the following pre-operative tests is most essential prior to performing surgery for rectal prolapse?

a. Pelvic MRI

b. Sitz marker study

c. Colonoscopy

d. Electromyography

4. The single “best” surgery for rectal prolapse is:

a. Altemeier procedure

b. Delorme procedure

c. Ventral rectopexy

d. It depends on the patient

Answers

1. c

2. d

3. c

4. d

Liliana Bordeianou and Caitlin W. Hicks are co-first authors.

This article was submitted on behalf of the Continuing Education Committee of the SSAT.

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Bordeianou, L., Hicks, C.W., Kaiser, A.M. et al. Rectal Prolapse: An Overview of Clinical Features, Diagnosis, and Patient-Specific Management Strategies. J Gastrointest Surg 18, 1059–1069 (2014). https://doi.org/10.1007/s11605-013-2427-7

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  • DOI: https://doi.org/10.1007/s11605-013-2427-7

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