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Rectal prolapse in infancy: conservative versus operative treatment
Insights
Infantile rectal prolapse has two types: intermittent and pronounced. Conservative treatment resolves mild cases, while surgical intervention, like the Lockhart-Mummery operation, effectively treats severe or persistent rectal prolapse in infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Rectal prolapse in infants presents with varying severity.
- Two distinct types of infantile rectal prolapse are observed: intermittent and pronounced.
Purpose of the Study:
- To differentiate between the two types of infantile rectal prolapse.
- To evaluate treatment outcomes for both types of rectal prolapse in infants.
- To assess the efficacy of the Lockhart-Mummery operation for severe infantile rectal prolapse.
Main Methods:
- Classification of rectal prolapse into intermittent and pronounced types.
- Observation of treatment response to conservative measures for intermittent prolapse.
- Surgical intervention using the Lockhart-Mummery operation for persistent or severe prolapse.
Main Results:
- Nine out of 17 infants with rectal prolapse experienced the intermittent type, which resolved with conservative treatment.
- The pronounced type of rectal prolapse required surgical intervention.
- The Lockhart-Mummery operation was successful in all but one patient with pronounced rectal prolapse, with no observed complications.
Conclusions:
- Conservative treatment is effective for intermittent infantile rectal prolapse.
- The Lockhart-Mummery operation is a safe and effective alternative for severe infantile rectal prolapse when conservative measures fail.
- Pathoanatomically, infantile rectal prolapse is often a mucosal prolapse, supporting less invasive initial treatments.
Abstract:
In infancy there are two types of rectal prolapse. One type is less pronounced and intermittent. This type occurred in 9 out of 17 children referred for rectal prolapse and ceased after a few weeks' conservative treatment. The other type is a more pronounced prolapse occurring at nearly each defecation and lasting several weeks or months. These patients may need an operation, especially when ulceration of the mucosa occurs. In our patients, a Lockhart-Mummery operation was used successfully in all but one patient. No complications were observed. Though less extensive treatment, such as submucosal injection of sclerosing agents, is recommended to be the first method of choice because pathoanatomically the prolapse in infancy is frequently a prolapse of the mucosa, in patients where this therapy does not succeed, a Lockhart-Mummery operation may be an alternative.