Search

Background: Aluminum potassium sulfate and tannic acid is a sclerosant used for sclerosing therapy in the treatment of hemorrhoids, and a Leeds-Keio artificial ligament is a new anal-encircling material for the management of rectal prolapse., Objective: The aim of this study was to evaluate clinical data and recurrence rates in patients with rectal prolapse undergoing combined aluminum potassium sulfate and tannic acid injection and anal encirclement using the Leeds-Keio artificial ligament., Design: This was a retrospective review of patients who underwent this procedure., Settings: This study was conducted at a community-based hospital within a specialized colorectal unit., Patients: A total of 23 patients (20 women; median age, 83 years) with full-thickness rectal prolapse underwent treatment between 2005 and 2010., Main Outcome Measures: The main outcome measures were morbidity and recurrence rate., Results: The median duration of surgery was 36 minutes. Mean total injection dose of aluminum potassium sulfate and tannic acid was 30 mL. There were no postoperative deaths. Wound infection occurred in 2 patients (9%), and new or worsening symptoms of constipation after surgery occurred in 6 patients (26%). There were 3 recurrences at a median follow-up of 36 months (range, 7-86 months). Recurrence rate at 5 years was 14% (95% CI, 5%-35%)., Limitations: The limitations of this study include its retrospective nature, the potential for selection bias, and lack of a control group., Conclusions: This procedure is quick and easy to perform, with no formidable morbidity, and the recurrence rate is reasonably low. Therefore, it seems to be a reasonable alternative for rectal prolapse in frail, elderly, and high-risk patients.

Purpose: No surgical method for repair of total rectal prolapse has been established as optimal. We describe a new technique that uses ALTA (aluminum potassium sulfate and tannic acid) injection as a simple perianal procedure for total rectal prolapse., Methods: Fourteen patients with total rectal prolapse were treated with sclerosing therapy by using ALTA injection. Via a perianal approach, 0.5 to 1 ml of ALTA solution was injected along a linear track into the submucosa at 30 to 80 different sites, totaling 20 to 60 ml., Results: All 14 patients treated with injection sclerotherapy were cured, with no intraoperative or postoperative complications. One patient required a repeat injection after two months to be cured. No exacerbation of constipation has resulted, and no stenosis has been evident on rectal examination. In seven of ten patients presenting with fecal incontinence, this complaint resolved after therapy., Conclusions: ALTA sclerotherapy yielded satisfactory results in total rectal prolapse, causing no alteration in neurophysiology of bowel function. Injection sclerotherapy should be recommended as the first procedure for treatment of total rectal prolapse.

Purpose: Rectal prolapse in children is not uncommon and usually is a self-limiting condition in infancy. Most cases respond to conservative management; however, surgery is occasionally required in cases that are intractable to conservative treatment. This study was designed to analyze the outcomes of rectal prolapse in children and to propose a pathway for the management of these cases in children., Methods: A retrospective analysis of all cases of rectal prolapse referred to our surgical unit during a period of five years was performed. End point was recurrence of prolapse requiring manual reduction under sedation or an anesthetic. Results are presented as median (range) and statistical analysis was performed using chi-squared test; P < 0.05 was considered significant., Results: A total of 49 children (25 males) presented with symptoms of rectal prolapse at a median age of 2.6 years (range, 4 months -10.6 years). All children received an initial period of conservative treatment with watchful expectancy and/or laxatives. Twenty-five patients were managed conservatively without any additional procedures (Group A), and 24 patients had one or more interventions, such as injection sclerotherapy, Thiersch procedure, anal stretch, banding of prolapse, and rectopexy (Group B). Management of rectal prolapse was successful with no recurrences in 24 patients (96 percent) in Group A vs. 15 patients (63 percent) in Group B at a median follow-up period of 14 (range, 2-96) months. An underlying condition was found in 84 percent of patients in Group A vs. 54 percent in Group B (P = 0.024). The age at presentation was younger than four years in 88 percent of patients in Group A vs. 58 percent in Group B (P = 0.019)., Conclusions: Rectal prolapse in children does respond to conservative management. A decision to operate is based on age of patient, duration of conservative management, and frequency of recurrent prolapse (>2 episodes requiring manual reduction) along with symptoms of pain, rectal bleeding, and perianal excoriation because of recurrent prolapse. Those cases presenting younger than four years of age and with an associated condition have a better prognosis. The authors propose an algorithm for the management of rectal prolapse in children.

Reduction of a large rectal prolapse may be difficult because of significant edema that collects in the rectal tissues. If reduction is unsuccessful, an emergent laparotomy and internal reduction is required. A wide elastic wrap applied around the prolapsed rectum provides progressive compression, which reduces the amount of edema, allowing subsequent manual reduction. This novel technique is simple, safe, inexpensive, and can easily be performed in the emergency department setting. Manual reduction, by this or other described methods, should be attempted before emergent laparotomy for incarcerated rectal prolapse is performed.

Purpose: Rubber band ligation is a common office procedure for symptomatic hemorrhoids. The aim of the study was to assess our short-term and long-term results of combined sclerotherapy and rubber band ligation in the management of hemorrhoids and incomplete mucosal prolapse., Methods: Data on 6,739 patients who had previous combined sclerotherapy and rubber band ligation by the senior authors (GLN and PRD) were retrieved from the database dating between January 1976 and June 2000. These patients either had hemorrhoids or incomplete mucosal prolapse. Furthermore, questionnaires were sent to a random sample of 2,400 patients. Telephone interviews were performed for 600 of the nonrespondents., Results: Of 6,739 patients (3,683 males; mean age, 46.7 years) in the database, 4,686 (70 percent) received the procedure once, and 2,053 (30 percent) received the procedure more than once. There were 5,689 patients (84 percent) who had their procedures performed consecutively within a planned period, and only 1,050 patients (16 percent) had repeat procedures after a period of more than 12 months from their last treatments. Thus, the recurrence rate was 16 percent. The overall complication rate was 3.1 percent, with minor bleeding being the major complaint. With regard to the questionnaire, 44 percent responded. The mean follow-up period was 6.5 (range, 1-11) years. There were patients who had residual symptoms of bleeding (19 percent), itch (21 percent), and lump (20 percent). However, 58 percent of patients who replied were asymptomatic. With satisfaction scores ranging from +3 to -3 (+3 indicating complete satisfaction and -3 indicating complete dissatisfaction), 90 percent scored >/=1, 9 percent scored 0 or less, and 1 percent did not specify a score. Hemorrhoidectomy was required in 7.7 percent of the responders. Of 600 phone interviews with the nonrespondents, 152 responded to the questionnaires. Although there was less satisfaction from the phone respondents, which may have accounted for the initial nonresponse, no statistical difference was detected in residual symptoms., Conclusions: Combined triple sclerotherapy and rubber band ligation is an effective treatment for early hemorrhoids and incomplete mucosal prolapse, with low rates of recurrence, complications, and hemorrhoidectomy, and it can be repeated easily.

We report a case of incarcerated rectal prolapse that could not be reduced after using the previously described application of ordinary table sugar. Gentle pressure caused the prolapsed rectum to perforate, and the small bowel herniated through the tear. This is only the second case reported in the literature of an ileal herniation through a perforated rectum after an attempted reduction of an incarcerated prolapse. It is the only reported case occurring after sugar application and the 42nd case of ileal herniation through the rectum from all causes.

Fifty-six patients were treated for rectal prolapse or incontinence. Rectal prolapse was present in 32 patients and was associated with fecal incontinence in 24 (75 per cent). Incontinence without prolapse was present in 24 patients, 12 of whom were less than 40 years old. Rectopexy was used for treatment of rectal prolapse. Surgical treatment of fecal incontinence was by postanal repair; external sphincter reconstruction and surgery was advised only if control of diarrhea and electrical therapy had been of no benefit. Rectopexy was completely successful at controlling rectal prolapse in all cases, and only four of the 20 (20 per cent) patients with incontinence and prolapse remained incontinent after rectopexy alone. Incontinence was completely controlled by postanal repair in 58 per cent of patients and by external sphincter repair alone or in combination with postanal repair in 67 per cent. Using a combination of therapies 45 of 48 patients who were initially incontinent were improved (94 per cent), and 42 of the patients have complete control of defecation (87 per cent).

Rectal prolapse in children is an uncommon clinical entity in western countries. Treatment is generally supportive with surgery reserved for the intractable case. If operative intervention is advised, it should consist of one of several limited procedures that can be safely performed with low morbidity: anal encirclement, presacral packing, sclerosing injection, or linear rectal cauterization.