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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The recent use of the posterior sagittal anorectoplasty for repair of high imperforate anus has demonstrated several advantages: elimination of laparotomy, more direct approach, easier division of rectourethral fistula, more exact identification of the muscles of fecal continence, proper relocation of anorectum within these muscles and sphincters, and virtual elimination of postoperative anal prolapse. It is this latter advantage that attracted us to use this procedure for the repair of a recurrent rectal prolapse in a 1-year-old girl who also had a recurrent bladder exstrophy. The latter probably contributed to her constantly pushing out her rectum, which easily admitted two fingers. Two attempts were made to repair the rectal prolapse using the subcutaneous Thiersch's perianal technique; however, each was successful for only 6 weeks. When her recurrent bladder exstrophy was repaired, we also repaired her recurrent rectal prolapse using the posterior sagittal anorectoplasty. The midline sacrococcygeal incision was carried down to but not through the external sphincter, and the patulous rectum was plicated back to a normal size. Reapproximation of the levator sling and lower muscle complex then incorporated the plicated rectum. Both repairs remain intact after 1 year.
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PMID:Posterior sagittal anorectoplasty for pediatric recurrent rectal prolapse. 280 60

We have examined the occurrence and distribution of endocrine cells storing serotonin and the regulatory peptides somatostatin, glicentin, peptide YY in rectal mucosa on 16 patients with prolapse or intussusception of the rectum. There were no significant differences compared with normal rectal mucosa. Our results do not support the assumption that these endocrine cells of the rectum are involved in the pathophysiology of rectal prolapse.
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PMID:Endocrine cells in the human colorectal mucosa: immunocytochemical observations on patients with prolapse or internal procidentia of the rectum. 288 22

Posterior abdominal rectopexy was performed in 12 patients with a full-thickness rectal prolapse: 9 had faecal incontinence. The prolapse was successfully controlled in all cases and six of nine patients were rendered continent. Physiological studies in patients were compared with age- and sex-matched controls. Preoperative anal pressures were significantly lower than in controls at rest (R), during maximum pelvic floor contraction (Sq) and attempted defaecation (St) (R, P less than 0.005; Sq, P less than 0.005; St, P less than 0.005). Anorectal angles were significantly more obtuse in patients than in controls (R, P less than 0.05; St, P less than 0.025). None of these parameters changed significantly after abdominal rectopexy. Median rectal emptying significantly decreased after operation (preoperative 83 per cent/min; postoperative, 58 per cent/min, P less than 0.05). Median perineal descent during attempted defaecation also significantly decreased after operation (preoperative, 8.5 cm; postoperative, 7.1 cm; P less than 0.025). Parameters which predicted return of continence included: delayed leakage during the saline infusion test (P less than 0.025), a narrow anorectal angle during pelvic floor contraction (P less than 0.025), minimal pelvic floor descent during contraction (P less than 0.05), and a long anal canal at rest (P less than 0.05) and during pelvic floor contraction (P less than 0.025).
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PMID:Anorectal function after abdominal rectopexy: parameters of predictive value in identifying return of continence. 263 77

A modified sling rectopexy to the sacrum was performed in a series of 104 patients with complete rectal prolapse during 1975-86. A sling of mersilene mesh was sutured to the front of the sacrum and to the sides of the rectum without enclosing its anterior surface. A postoperative mortality of 2% and morbidity of 23% were found. Control of the prolapse was achieved in over 90% of cases and the continence rate rose from a preoperative level of 37% to 86% postoperatively. This form of abdominal repair is an effective method of correcting complete rectal prolapse in the majority of cases.
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PMID:An abdominal repair for complete rectal prolapse. 297 69

Rectal prolapse is best treated by intra-abdominal or perineal procedures that either resect the redundant rectosigmoid colon or fix the rectum within the pelvis. We have found the Thiersch procedure to be adequate treatment in patients who are high risk or who have only mild to moderate prolapse of the rectum. Over the past 20 years, we have treated 15 patients with a modified Thiersch procedure, using a knitted Dacron vascular graft to encircle the anus. One patient required a second Thiersch procedure after failure of a Ripstein procedure that followed failure of a Thiersch procedure done with wire. A second Thiersch procedure was required in two patients after suture breakage, and in one patient after removal of an infected graft. Two other patients had graft infections necessitating removal of the Dacron graft; one patient had a perianal infection that was treated without removing the graft. Continence was achieved in six of nine patients previously incontinent, and maintained in the six patients who had been continent before operation. Prolapse was corrected in 13 of the 15 patients. Although the Thiersch procedure is not applicable to all patients with rectal prolapse, it can be used successfully when performed properly.
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PMID:Modified Thiersch operation for rectal prolapse. Technique and results. 315 38

Perineal excision of rectal prolapse with simultaneous posterior levator ani repair was used to treat 41 elderly patients with rectal procidentia. The majority of the patients had significant associated risk factors. This procedure was performed with minimal morbidity and no mortality. A significant improvement in anal continence was seen in 78 percent of patients. The recurrence rate of rectal prolapse was 4.8 percent.
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PMID:Perineal excision of rectal prolapse with posterior levator ani repair in elderly high-risk patients. 316 81

A prospective cohort study was designed to describe the patterns and to determine the factors associated with the risk of rectal prolapse in a commercial swine herd in California, USA. Thirty (1.0 per cent) of 2862 pigs prolapsed between 12 and 28 weeks of age with the peak incidence occurring in 14- to 16-week-old pigs. The overall prolapse rate was 9.1 cases per 100,000 days at risk. Prolapse rates were highest during the winter and autumn months. Other factors associated with an increased risk of prolapse were maleness (relative risk 2.3) birthweight less than 1000 g (relative risk 3.4) Yorkshire boar A (relative risk 2.8) and dams of litter number 1 (relative risk 14.9), 2 (relative risk 8.2) and 3 (relative risk 9.8). No evidence was found to support the hypothesis that diarrhoea and coughing are factors associated with a risk of prolapse.
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PMID:Patterns and determinants of rectal prolapse in a herd of pigs. 317 83

The authors described their African experience on the basis of ten cases of total rectal prolapse in the young adult and child. Total rectal prolapse and internal procidentia fall within the general context of disorders of rectal mechanics. In most instances, such forced prolapse occurs in young individuals who are usually muscular and used to difficult work. Nevertheless, defecation efforts in these chronically constipated patients play a significant role. Furthermore, there is frequently a concomitant presence of a megadolichosigmoid colon. In all cases treatment was surgical, involving rectopexy at the promontory using strips of fascia lata or even peritoneum. The post-operative course was in all cases uneventful with no recurrences and the routine prescription of adjuvant treatment for constipation.
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PMID:[Total rectal prolapse in young adults. Apropos of 10 cases in Africans]. 323 Jan 10

A review of 21 patients with protruded lesions in solitary ulcer syndrome of the rectum confirmed by resection is presented. Symptoms were usually the passage of blood and mucus per rectum, alteration of bowel habit, anorectal pain and rectal prolapse. Solitary or multiple polypoid lesions were found within 15 cm of the anal margin and were usually sited anteriorly. Fifteen of the patients were men and 8 were women with a mean age of 37.1 years. The diagnosis was made on the basis of histopathology; 1) fibrous obliteration of muscle fibers, 2) reactive hyperplasia of the mucous membrane with villous configuration or mild pseudoinvasion. These changes have been observed in complete rectal prolapse, colonic intussusception, and localized colitis cystica profunda, suggesting a common pathogenesis. The histological findings were almost the same as in the ulcerative lesions of this syndrome except for remarkable regenerative hyperplastic changes such as a relatively high incidence of mucous cell proliferation, dilatation of glands and serrate change in the cases showing protrusion. In the pathogenesis, the occult mucosal prolapse in association with excessive straining may be of particular importance, so that the lesions might be termed mucosal prolapse syndrome of the rectum.
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PMID:Protruded variants in solitary ulcer syndrome of the rectum. 326 Nov 11

In 46 patients with complete rectal prolapse a simple method of rectopexy was used, fixing the mobilized rectum to the sacrum with sutures. In 17 cases the rectopexy was supplemented with levator sutures. The patients' age range was 20-87 years and follow-up was 6 months to 17 years. There was no associated mortality and almost no morbidity. Prolapse recurred in two cases, in one of them due to incomplete fixation because of a congenital pelvic deformity. Rectopexy with sutures seemed to give results as good as the Teflon mesh and Ivalon sponge methods in regard to recurrence rate, while avoiding the complication risks associated with insertion of foreign material.
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PMID:Repair of rectal prolapse by rectosacral suture fixation. 328


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