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Published on: April 17, 2019
Rectal Prolapse in the Pediatric Population
James K Moon1, John D Stratigis2, Aaron M Lipskar2
1Northwell, Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA. jmoon6@northwell.edu.
Insights
Pediatric rectal prolapse management varies. Bowel programs are effective, but refractory cases benefit from sclerotherapy or transabdominal rectopexy, favored by pediatric surgeons.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Rectal prolapse in children presents diverse challenges in diagnosis and treatment.
- Understanding varied etiologies and presentations is crucial for effective management.
Purpose of the Study:
- To review evidence for medical and surgical treatments in pediatric rectal prolapse.
- To highlight recent trends in management among pediatric surgeons.
Main Methods:
- Literature review of treatment options for pediatric rectal prolapse.
- Analysis of current trends in surgical interventions.
Main Results:
- Medical therapy, particularly bowel management programs, is highly effective for most pediatric cases.
- Sclerotherapy (ethanol, phenol) and injections (hypertonic saline, dextrose, Deflux) are safe local alternatives.
- Transabdominal rectopexy is favored for refractory cases, especially post-recurrence, while less invasive procedures exist.
Conclusions:
- Medical management yields excellent outcomes for pediatric rectal prolapse.
- Sclerotherapy and transabdominal rectopexy are effective for refractory cases and preferred by many pediatric surgeons.
Purpose Of Review:
Rectal prolapse in the pediatric population presents a clinical challenge with wide variability in etiology, presentation, work-up and management. In this article, we reviewed the evidence supporting various medical and surgical treatment options as well as the recent trends amongst pediatric surgeons.
Recent Findings:
Medical therapy is highly effective in most patients, with bowel management programs being particularly successful. Nonetheless, medically refractory disease, often seen in older children and in children with behavioral/psychiatric disorders, can be challenging. Sclerotherapy with ethanol or 5% phenol can be effective local treatments. 15% hypertonic saline, 50% dextrose, and Deflux are additional safe alternatives. Perianal procedures and perineal procedures are less invasive surgical options, but transabdominal rectopexy appears to be the favored treatment for disease refractory to local treatment. Transabdominal rectopexy with sigmoidectomy, the recommended operation in the adult population for patients with prolapse and constipation, appears only to be preferred in the pediatric population for postoperative recurrences.
Recent Findings:
While outcomes of medical treatment for pediatric rectal prolapse are excellent, sclerotherapy and transabdominal rectopexy are effective options for refractory disease preferred by most pediatric surgeons.
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