The document provides tips for using a PowerPoint presentation on rectal prolapse. It recommends: 1. Freely editing and modifying the slides and adding your name. 2. Noting that half the slides are blank except for the title to facilitate active learning sessions. 3. Showing blank slides, asking students what they know, and then showing the content slide. 4. Rerunning the show at the end to reinforce learning. 5. Using this approach for 3 revisions to optimize learning. It also provides the presentation format and sample content slides on topics like relevant anatomy, aetiology, clinical features, and management of rectal prolapse.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Format

3. Format
1. Introduction & History
2. Relevant Anatomy, Physiology
3. Aetiology
4. Pathophysiology
5. Pathology
6. Classification
7. Clinical Features
8. Investigations
9. Management
10.Prevention

4. Introduction & History.

5. Introduction & History.
• Rectal prolapse occurs when a mucosal or
full-thickness layer of rectal tissue protrudes
through the anal orifice.
• Three different clinical entities are often
combined under the umbrella term rectal
prolapse:
1. Full-thickness rectal prolapse
2. Mucosal prolapse
3. Internal prolapse (internal intussusception)

6. Introduction & History.
• Full-thickness rectal is defined as protrusion of
the full thickness of the rectal wall through the
anus; it is the most commonly recognized type.
• Mucosal prolapse, in contrast, is defined as
protrusion of only the rectal mucosa (not the entire
wall) from the anus.
• Internal intussusception may be a full-thickness
or a partial rectal wall disorder,
• Today we shall focus on full-thickness rectal
prolapse, which will be referred to as rectal
prolapse.

9. Relevant Anatomy

10. Relevant Anatomy
Common anatomic features-
• Patulous or weak anal sphincter
• Levator diastasis,
• deep anterior Douglas cul-de-sac,
• poor posterior rectal fixation with a long
rectal mesentery,
• Redundant rectosigmoid.
Whether these anatomic features are the cause
or result of the prolapsing rectum is not
known.

11. Relevant Anatomy
Common anatomic features in children-
• vertical orientation of the rectum,
• the mobility of the sigmoid colon,
• the relative weakness of the pelvic floor
muscle
• mucosa that is poorly fixed to submucosa
• Redundant rectal mucosa..

12. Aetiology
• Idiopathic
• Congenital/ Genetic
• Nutritional Deficiency/excess
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative
• Iatrogenic
• Psychosomatic

13. Associated conditions-
• chronic straining with
defecation and
constipation.
• Pregnancy
• Previous surgery
• Diarrhea
• Benign prostatic
hypertrophy
• Chronic obstructive
pulmonary disease
(COPD)
•
• Cystic fibrosis
• Pertussis (ie,
whooping cough)
• Pelvic floor
dysfunction
• Parasitic infections –
Amebiasis,
schistosomiasis
• Disordered defecation
(eg, stool withholding)
• Neurologic disorders -

14. Associated conditions-
• Neurologic disorders - Previous lower
backor pelvic trauma/lumbar disk disease,
cauda equina syndrome, spinal tumors,
multiple sclerosis

15. Pathophysiology

16. Pathophysiology
• The pathophysiology of rectal prolapse is not
completely understood or agreed upon.
• The first theory postulates that rectal prolapse is a
sliding hernia through a defect in the pelvic fascia.
• The second theory holds that rectal prolapse starts
as a circumferential internal intussusception of the
rectum beginning 6-8 cm proximal to the anal
verge.
• Often, prolapse begins with an internal prolapse of
the anterior rectal wall and progresses to full
prolapse.

17. Clinical Features

18. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

19. Demography

20. Demography
• The annual incidence 2.5 per 100,000
• peak incidences are observed in the fourth
and seventh decades of life.
• Pediatric patients usually are affected when
younger than 3 years with the peak
incidence in the first year of life.
• The incidence of prolapsed rectum in
children with cystic fibrosis approaches
20%.

21. Demography
• In the adult population, the male-to-female
ratio is 1:6.
• pediatric population: equal

22. Symptoms

23. Symptoms
• Mass protruding through the anus
• Pain
• Some 10-25% of patients also have uterine
or bladder prolapse,
• and 35% may have an associated cystocele.
• Constipation occurs in 15-65% of cases.
• There may also be rectal bleeding.
• fecal incontinence

24. Symptoms
• mass protruding through the anus
• Initially only after a bowel movement and
usually retracts when the patient stands up.
• As the disease process progresses, the mass
protrudes more often, especially with
straining and Valsalva maneuvers such as
sneezing or coughing.
• Finally, the rectum prolapses with daily
activities such as walking and may progress
to continual prolapse.

25. Symptoms
• As the disease progresses, the rectum no
longer spontaneously retracts, and patients
may have to replace it manually.
• may then progress to a point where the
rectum prolapses immediately after being
replaced and is continuously prolapsed.
• Rarely, the rectum becomes incarcerated,
and patients cannot replace the rectum.

26. Signs

27. Signs
• Protruding rectal mucosa
• Thick concentric mucosal ring
• Sulcus noted between anal canal and rectum
• Solitary rectal ulcer (10-25%)
• Decreased anal sphincter tone
• The patient is asked to sit on a toilet and
strain, after which the rectum should
prolapse.
• phosphate enema glycerin suppository

28. Signs
• The protruding mass should show
concentric rings of mucosa.
• Mucosal prolapse typically exhibits radial
folds instead of concentric rings.

29. Prognosis

30. Prognosis
• The prognosis generally is good with
appropriate treatment.
• Spontaneous resolution usually occurs in
children.

31. Complications

32. Complications
Uncommon
• incarceration and strangulation (rare).
• Bleeding
• Ulceration
• Incontinence

33. Investigations

34. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology

35. Investigations
• Laboratory Studies
– sweat chloride test for pediatric patients; as
many as 11% of children with rectal prolapse
have cystic fibrosis.

36. Diagnostic Studies

37. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

38. Diagnostic Studies
Imaging Studies
• Rigid proctosigmoidoscopy- solitary rectal
ulcers.
• Colonoscopy
• Barium enema
• Video defecography
– internal prolapse or to distinguish rectal
prolapse from mucosal prolapse
– intussusception of proximal colon
– pelvic outlet obstruction.

39. Diagnostic Studies
Other Tests
• Anal-rectal manometry
• The Sitz marker study
• Pudendal nerve terminal motor latency

40. Differential Diagnosis

41. Differential Diagnosis
• Hemorrhoids
• Intussusception
• Proctitis
• Rectal polyps
• Evaluate pediatric patients for cystic
fibrosis

42. Management

43. Management
• In adult patients, treatment of rectal
prolapse is essentially surgical;
• Children, however, can usually be treated
nonsurgically.

44. Non Operative Therapy

45. Non Operative Therapy
• Reduce with gentle digital pressure
sedation,
• Field block with local anesthetic
• Sprinkling the prolapse with either salt or
sugar to decrease the edema.
• Manage constipation and diarrhea

46. Emergency Surgery

47. Emergency Surgery
• If the prolapse cannot be reduced and the
viability of the bowel is in question
• Rupture of the rectum

48. Operative Therapy
•

49. Operative Therapy
• Surgical treatments can be divided into two
categories-
1. Abdominal procedures
2. Perineal procedures.
• The abdominal procedures have a lower
recurrence rate but a higher morbidity.
• Older, debilitated patients -perineal
procedures
• Younger, healthier patients -abdominal
procedures.

50. Operative Therapy
Abdominal procedures
• Anterior resection
• Ripstein procedure Marlex rectopexy-
Marlex mesh or an Ivalon sponge.
• Suture rectopexy
• Laparoscopic surgical rectopexy
• Frykman-Goldberg procedure- resection
with rectopexy

51. Operative Therapy
Perineal procedures
• Anal encirclement Thiersch wire
• Delorme mucosal sleeve resection
• Altemeier perineal rectosigmoidectomy
• Hemorrhoidectomy-Mucosal prolapse
• Perineal stapled prolapse resection

52. Minimally invasive Therapy
• A laparoscopic approach to rectal prolapse
repair

53. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

56. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
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• https://www.facebook.com/doctorpradeeppa
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