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Sclerotherapy for the management of rectal prolapse in children
Scott C Dolejs1, Justin Sheplock1, Robert J Vandewalle1
1Indiana University School of Medicine, Division of Pediatric Surgery.
Insights
Sclerotherapy offers a durable cure for most pediatric rectal prolapse cases. Recurrences typically occur within four months, and repeat sclerotherapy is a reasonable and often successful treatment option.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Rectal prolapse is common in children, often resolving spontaneously.
- Surgical intervention is reserved for cases unresponsive to conservative measures.
- Optimal surgical techniques for pediatric rectal prolapse remain debated.
Purpose of the Study:
- To evaluate the efficacy of injection sclerotherapy for treating rectal prolapse in children.
- To determine long-term outcomes and recurrence rates following sclerotherapy.
Main Methods:
- Retrospective review of pediatric patients (<18 years) treated with sclerotherapy (predominantly peanut oil) between 1998 and 2015.
- Exclusion criteria included imperforate anus, cloaca abnormalities, Hirschsprung disease, and prior pull-through procedures.
- Study design: Treatment Study, Level IV evidence.
Main Results:
- Seventy-seven percent (44/57) of patients achieved a cure with initial sclerotherapy.
- Recurrence occurred in 35% (20/57) of patients, mostly within four months.
- Repeat sclerotherapy was successful in 56% (5/9) of recurrent cases; 10% (2/20) had mucosal recurrence resolving conservatively.
- No adverse events were reported with sclerotherapy; 23% (3/13) recurred after subsequent rectopexy.
Conclusions:
- Injection sclerotherapy provides a durable cure for the majority of pediatric rectal prolapse cases.
- Sclerotherapy is a safe and effective first-line treatment for pediatric rectal prolapse.
- Re-treatment with sclerotherapy for recurrences is a viable and successful option.
Purpose:
Rectal prolapse is a commonly occurring and usually self-limited process in children. Surgical management is indicated for failures of conservative management. However, the optimal approach is unknown. The purpose of this study is to determine the efficacy of sclerotherapy for the management of rectal prolapse.
Methods:
This was a retrospective review of children <18years with rectal prolapse who underwent sclerotherapy, predominantly with peanut oil (91%), between 1998 and 2015. Patients with imperforate anus or cloaca abnormalities, Hirschprung disease, or prior pull-through procedures were excluded.
Results:
Fifty-seven patients were included with a median age of 4.9years (interquartile range (IQR) 3.2-9.2) and median follow-up of 52months (IQR 8-91). Twenty patients (n=20/57; 35%) recurred at a median of 1.6months (IQR 0.8-3.6). Only 3 patients experienced recurrence after 4months. Nine of the patients who recurred (n=9/20; 45%) were re-treated with sclerotherapy. This was successful in 5 patients (n=5/9; 56%). Two patients (n=2/20; 10%) experienced a mucosal recurrence which resolved with conservative management. Forty-four patients were thus cured with sclerotherapy alone (n=44/57; 77%). No patients undergoing sclerotherapy had an adverse event. Thirteen patients (n=13/20; 65%) underwent rectopexy after failing at least one treatment of sclerotherapy. Three of these patients (n=3/13; 23%) recurred following rectopexy and required an additional operation.
Conclusions:
Injection sclerotherapy for children with rectal prolapse resulted in a durable cure of prolapse in most children. Patients who recur following sclerotherapy tend to recur within 4months. Another attempt at sclerotherapy following recurrence is reasonable and was successful half of the time. Sclerotherapy should be the preferred initial treatment for rectal prolapse in children and for the initial treatment of recurrence.
Level Of Evidence:
Level IV.
Type Of Study:
Treatment Study.
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