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

The etiology and treatment of rectal procidentia remain controversial despite its longtime recognition. In this article, the clinical manifestations, etiology, and therapeutic options of both forms of rectal prolapse and the associated syndromes of colitis cystica profunda and solitary ulcer of the rectum are reviewed.
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PMID:Internal and overt rectal procidentia. 329 55

Rectopexy in the sacral hollow or to the promontory with synthetic material is the most efficient method of reducing and fixing a complete rectal prolapse. However, this distressing condition occurs frequently in elderly patients, often with high operative risk. In these some surgeons have advocated a perineal approach. Eighteen female patients (mean age 74 years) with complete rectal prolapse have been treated by a modified Delorme's procedure which involves a mucosal stripping of the prolapse and longitudinal plication of the muscular wall of the rectum. There was no postoperative mortality or morbidity. After a mean follow-up of 18 months, two complete recurrences occurred. These were treated by the same technique with a good result at 3 years. One other patient presented a partial and intermittent recurrence. Incontinence has improved in four patients and was not made worse in the others. Our results and those previously published show that this procedure is safe in elderly high risk patients considered too unfit for transabdominal surgery.
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PMID:Treatment of rectal prolapse by Delorme's operation. 330

Between 1970 and 1985 (inclusive), 66 patients presented with complete rectal prolapse; 59 (89 per cent) were treated by extended abdominal rectopexy. Forty-four patients (75 per cent) have been followed for more than 2 years: all cases were cured of their complete prolapse, no patients died, and major complications were few. Constipation (47 per cent) and incontinence (19 per cent) caused serious problems for many patients postoperatively.
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PMID:Complete rectal prolapse: the anatomical and functional results of treatment by an extended abdominal rectopexy. 333 47

Seven female patients with clinical rectal prolapse and nine healthy female control subjects were studied with anorectal manometry, external sphincter electromyography, and a saline continence test. Resting anal tone, maximum voluntary squeeze, and rectal functional capacity were significantly decreased in the rectal prolapse patients (p less than 0.02). During defecation attempts, external sphincter or pelvic floor electromyographic activity decreased in all of the control subjects, whereas six prolapse patients showed increased electromyographic activity and one had no change in activity (p less than 0.01). Continence to saline solution was also significantly impaired in prolapse patients (p less than 0.001). Postoperative studies in three patients who underwent repair revealed persistence of abnormal anorectal function and defecation dynamics. Patients with rectal prolapse have impaired resting and voluntary sphincter activity, decreased functional rectal capacity, and impaired continence. The failure of normal relaxation of the external sphincter or pelvic floor during defecation attempts, as demonstrated in the patients described herein, may contribute to the development of prolapse and denervation sphincter injury seen in such patients.
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PMID:Anorectal function and defecation dynamics in patients with rectal prolapse. 334 44

Fifty-four pediatric patients with rectal prolapse (RP) were identified by review of medical records from 1977 to 1987. Rectal prolapse was attributed to chronic constipation (15 patients), acute diarrheal disease (11 patients), cystic fibrosis (CF) (six patients), and neurologic/anatomic abnormalities (13 patients). In nine patients, no underlying cause was identified. The patients with CF did not differ from the other groups in terms of age at time of onset of prolapse, growth measurements, or number of episodes of prolapse. All patients with CF had a history of abnormalities or presented with signs and symptoms consistent with this diagnosis; none had a history of constipation. Although physicians can be reassured that CF is not a likely diagnosis in patients with RP and acute diarrheal disease or a clear history of constipation, a sweat test is indicated in all such cases as well as in those in which there is no apparent underlying cause. A sweat test is not usually indicated in patients with RP in association with underlying anatomic abnormalities.
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PMID:The cause of rectal prolapse in children. 334 23

We reviewed our 22-year experience with 135 Ripstein procedures for rectal prolapse in 118 women and 17 men. Follow-up ranged from one to 256 months (median, 41 months). Five patients were unavailable for follow-up. There was one perioperative death (0.7%). Complications included hemorrhage from presacral veins in 11 patients (8.1%), recurrent prolapse in 13 patients (9.6%), and stricture at the site of the sling in three patients (2.2%). Specific intraoperative technical factors could be related to recurrent prolapse in four patients (30.8%). Attention to technical details is mandatory to minimize immediate and long-term complications. Patients should be prepared for anterior resection, since a sling procedure may be inadvisable at the time of exploration. Resection may be the preferred operation for men, who have a high rate of recurrent prolapse with the Ripstein procedure.
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PMID:Ripstein procedure. Lahey Clinic experience: 1963-1985. 335 80

Twenty-one patients with rectal prolapse (N = 15) or internal rectal procidentia (N = 6) were investigated clinically and by anorectal manometry prior to and six months following rectopexy. Symptoms such as urgency, rectal pain, blood, and mucous discharge were markedly relieved by the operation. Rectal evacuation and number of bowel motions seemed to be unaffected. Rectal volume, sensibility, and compliance did not change following surgery. Rectal sensibility was reduced in these patients compared with 15 controls, but there was no difference in rectal volume or rectal compliance.
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PMID:Evacuation difficulties and other characteristics of rectal function associated with procidentia and the Ripstein operation. 335 98

Twenty-one patients suffering from rectal prolapse (n = 15) or internal rectal procidentia (n = 6) were investigated clinically and by anorectal manometry prior to and six months following retopexy. Rectal prolapse was associated with incontinence in 67% (10/15) of the patients preoperatively. The moderately or severely incontinent patients had lower than normal maximum anal resting pressures (MAP) and those with severe incontinence also had lower than normal maximum squeeze pressure (MSP). Postoperatively only 20% (3/15) of the patients remained incontinent and none of them suffered severe incontinence. MAP values increased significantly indicating that improvement of the function of the internal anal sphincter may be one of the factors contributing to better continence. Rectal sensibility was impaired in patients with rectal prolapse as compared to 15 controls. There was no postoperative change. Patients with internal rectal procidentia had normal MAP and MSP and no postoperative change could be demonstrated.
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PMID:Recovery of the internal anal sphincter following rectopexy: a possible explanation for continence improvement. 336 Dec 20

There are two muscular mechanisms of fecal continence. The anal sphincter squeezes the anal canal, thus lengthening it and increasing its resistance. The puborectalis kinks the distal rectum, preventing the transmission of intra-abdominal pressures into the anal canal. Balloon sphincterography simultaneously records the shape of the anal canal and distal rectum and measures the strength of the puborectalis and anal sphincter muscles. This allows the physician to evaluate the function of these important muscles in patients with symptomatic defecation disorders such as constipation, incontinence, and rectal prolapse. A cylindrical balloon is connected by a hose to a fluid reservoir filled with liquid barium. The deflated balloon is placed into the anal canal and inflated by raising the fluid reservoir in increments. Fluoroscopy visualizes the balloon's shape and video records the results. Quantitative sphincterogram measurements in patients with defecation disorders include (the three measurements in each category refer respectively to incontinent patients [N = 87], prolapse patients without incontinence [N = 26], and constipated patients [N = 65]); anorectal angle (degrees + S.D.): 114 + 28, 103 + 18, 95 + 19; anal canal length (mm + S.D.): 33 + 11, 38 + 10, 39 + 10; squeeze pressure (cm H2O + S.D.): 68 + 23, 80 + 16, 91 + 22, and opening pressure (cm H2O + S.D.): 52 + 25, 67 + 22, 81 + 24. The method is useful in identifying specific defects, such as paradoxic puborectalis contractions, that can cause constipation, and injuries to the sphincters that can cause incontinence. In over 280 patients with a wide variety of defecation disorders, sphincterography has yielded information not available by standard manometric techniques. It augments the findings of defecography.
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PMID:Balloon sphincterography. Clinical findings after 200 patients. 336 32

Defecographic evaluation was performed in 30 patients with rectal prolapse to assess the effect of posterior rectopexy on rectal function and to arrive at a selection of the best procedure. Preoperative defecography revealed rectal intussusception in all patients. Postoperative control studies showed adequate rectal fixation to the anterior sacral surface. Intussusception no longer occurred. Rectal stenosis due to the surgical procedure was absent. The described technique of posterior rectopexy eliminates the prolapse mechanism without creating new disorders and is therefore a rational procedure. Advocation of new procedures should also be based on results of colorectal tests that assess the effect of the procedures on rectal function.
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PMID:Toward a selection of the most appropriate procedure in the treatment of complete rectal prolapse. 336 34


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