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Published on: October 19, 2018
Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children
M A Baky Fahmy1, Sahar Ezzelarab
1Al Galaa Teaching Hospital, 25th July Street, Cairo, Egypt. mabfahmy@hotmail.com
Insights
This study compared sclerotherapy materials for treating partial rectal prolapse in children. Deflux showed the lowest complication rate and no recurrence, making it a preferred option over phenol or alcohol injections.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Materials Science
Background:
- Rectal prolapse in children is often linked to parasitic infections and poor toilet training in developing nations.
- Injection sclerotherapy is a common treatment for partial rectal prolapse, with various agents available.
- Comparing the efficacy and safety of different sclerosing agents is crucial for optimizing pediatric care.
Purpose of the Study:
- To compare the effectiveness and complication rates of three different sclerosing agents used for treating partial rectal prolapse in children.
- To identify the optimal sclerosing material with the lowest incidence of adverse events and recurrence.
Main Methods:
- A retrospective analysis of 130 children with partial rectal prolapse treated at Al Galaa Teaching Hospital over three years.
- Patients requiring injection sclerotherapy were divided into three groups: 98% ethyl alcohol, 5% phenol in almond oil, and Deflux.
- Clinical data and complications were recorded during follow-up periods ranging from two months to three years.
Main Results:
- Deflux demonstrated the lowest complication rate, with no long-term recurrence observed.
- Ethyl alcohol resulted in a higher short-term recurrence rate and long-term recurrence of 11%, with complications including mucosal sloughing and rectovaginal fistula.
- Phenol in almond oil showed a high complication rate, including abscess formation and perianal fistula in 18% of patients.
Conclusions:
- Deflux is the preferred sclerosing agent for pediatric partial rectal prolapse due to its superior safety profile and efficacy.
- Phenol in almond oil should be avoided due to its significant complication rate.
- Ethyl alcohol presents a viable, cost-effective alternative to Deflux, though with a higher recurrence risk.
Abstract:
Parasitic infestations, mainly enterobiasis and amoebiasis, and poor toilet training practices are commonly associated with rectal prolapse in developing countries. Injection sclerotherapy is one of the commonly used modalities for treating partial rectal prolapse in children. Various materials are available for such injection, but each has its advantages and complications. Comparing different materials used in the treatment of such pathology form the basis of this study trying to define the best material with the least complications. Data records of 130 children with partial rectal prolapse referred to the Department of Pediatric Surgery at Al Galaa Teaching Hospital, Cairo, over a 3-year period were analyzed. Their ages ranged from 6 months to 12 years (mean 6.14 years +/-3.4). Forty-five patients (3 5%) responded to conservative treatment, and 85 patients (65%) required injection sclerotherapy and were divided into three groups: Group 1 (35 patients) was injected with 98% ethyl alcohol, group 2 (22 patients) was injected with phenol in almond oil 5%, and group 3 (28 patients) was injected with Deflux (Q-Med, Uppsala, Sweden). The follow-up period ranged from 2 months to 3 years; clinical data and all complications were recorded. Submucosal injection of the three sclerosing materials showed no mortality in this series, but in group 1, seven had recurrence on short-term follow-up that required reinjection, and long-term follow-up in this group showed a recurrence rate of 11% (four patients), plus two patients had mucosal sloughing and one girl developed a rectovaginal fistula. Group 2 showed abscess formation and mucosal sloughing in four patients (18%), and two developed perianal fistula. Group 3 showed immediate postoperative prolapse in two cases that ameliorated spontaneously. No patients had mucosal ulceration or abscess formation, and long-term follow-up showed no recurrence. Deflux had the lowest complication rate with no recurrence on long-term follow-up. Phenol in almond oil 5% injection should not be used for treating such conditions because of its high complication rate. Alcohol is commercially cheap and available and should be considered an alternative for Deflux.
