Hépato-Gastro & Oncologie Digestive
MENURectal prolapse: How not to miss it? What to propose in 2017? Volume 24, issue 3, Mars 2017
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service de chirurgie digestive,
185, rue Raymond Losserand, 75014 Paris,
France
Institut de proctologie Léopold Bellan,
185, rue Raymond Losserand, 75014 Paris,
France
service de radiologie,
185, rue Raymond Losserand, 75014 Paris,
France
- Key words: rectal prolapse, intussuception, fecal incontinence, rectopexy, dyschesia
- DOI : 10.1684/hpg.2017.1436
- Page(s) : 266-75
- Published in: 2017
Rectal prolapse consists of a self-eversion of the rectal wall downwards during squeezing. Depending on the severity of the case eversion, the prolapse can stay inside the anal canal or reach the anus and go through the sphincter. Cases of permanent external rectal prolapse are not uncommon in elderly.
In case of internal prolapse, diagnostic can be challenging. Symptoms may include tenesma, urgencies, dyschesia, fecal incontinence, rectal bleeding, pelvic pain or difficulty to defecate, those are signs belonging to the “rectal prolapse syndrom” once must be aware of the diagnosis.
Cinedefecography and MRI-defecography are both useful to assess the diagnosis and evaluate the behavior of all the pelvic compartments during squeezing.
Only symptomatic patients must be directed to surgery and any case should be discussed inside a mutidisciplinary team. Ventral rectopexy is to date the first-line surgical option and can provide significative improvement in a majority of patients without onset of adverse defecatory side effects as did procedures performed in the past.