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Rectal prolapse in pediatrics
C Siafakas1, T P Vottler, J M Andersen
1Department of Pediatrics, UT Southwestern Medical Center at Dallas, Texas.
Insights
Pediatric rectal prolapse is a symptom of underlying conditions, often resolving spontaneously. Cystic fibrosis screening is crucial, and treatment focuses on the root cause, with surgery reserved for severe cases.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Rectal prolapse in children, particularly infants, is uncommon in industrialized nations.
- It presents as mucosal or complete rectal prolapse, often self-resolving before medical evaluation.
- Considered a symptom, not a disease, linked to increased intraabdominal pressure, diarrhea, malnutrition, and pelvic floor weakness.
Purpose of the Study:
- To review the etiology, diagnosis, and management of pediatric rectal prolapse.
- To highlight associated conditions, including cystic fibrosis and entities that may be overlooked.
- To discuss conservative and surgical treatment options.
Main Methods:
- Literature review of pediatric rectal prolapse.
- Analysis of potential underlying causes and associated conditions.
- Evaluation of diagnostic considerations and treatment modalities.
Main Results:
- Rectal prolapse is associated with cystic fibrosis, necessitating sweat testing.
- Occult rectal prolapse, solitary rectal ulcer syndrome, and inflammatory cloacogenic polyps require careful diagnosis.
- Conservative management targeting underlying conditions is primary; sclerosing agent injection is effective.
Conclusions:
- Pediatric rectal prolapse management requires addressing underlying etiologies.
- Early diagnosis and appropriate intervention improve outcomes.
- While often self-limiting, persistent cases may require specific treatments, with prognosis varying by age at presentation.
Abstract:
Rectal prolapse in pediatrics has its highest incidence in infancy and is uncommonly seen in industrialized countries. The prolapse may involve only the mucosa (mucosal prolapse) or all layers of the rectum (complete prolapse or procidentia). It is usually detected by the child's parents and is brought urgently to medical attention; however, it is usually spontaneously reduced by the time they reach the practitioner's office. Rectal prolapse should be viewed as a symptom of an underlying condition rather than a discrete disease entity. Potential causes are increased intraabdominal pressure, diarrheal and neoplastic diseases, malnutrition, and conditions predisposing to pelvic floor weakness. Its strong association with cystic fibrosis makes the sweat test mandatory for infants and children with recurrent rectal prolapse. Of particular importance are three entities related to rectal prolapse that may easily escape diagnosis by practitioner: occult rectal prolapse, solitary ulcer of the rectum syndrome, and inflammatory cloacogenic polyps. The treatment of rectal prolapse is mainly conservative and is directed at the underlying conditions. Surgical intervention may be required for recurrent rectal prolapse refractory to conservative measures. The simplest, less invasive, yet highly effective approach, appears to be perirectal injection with a sclerosing agent. While the majority of children experience spontaneous resolution of the prolapse, the prognosis is worse when presentation occurs after the age of 4 years.