Related Experiment Videos
[Anal prolapse in the child]
Insights
Rectal prolapse in children, including mucosal and total types, is discussed. While improved nutrition reduced mucosal prolapse in developed nations, malnutrition remains a key factor in underdeveloped countries, where it
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Context:
- Contrasts pediatric mucosal prolapse (ages 2-5) with rare total rectal prolapse.
- Highlights declining incidence of mucosal prolapse in industrialized nations due to improved nutrition.
- Emphasizes the continued severity and differing etiologies of rectal prolapse in under-developed countries.
Purpose:
- To differentiate between mucosal and total rectal prolapse in children.
- To discuss the causes, predisposing factors, and treatment of pediatric rectal prolapse.
- To highlight the impact of nutrition, prematurity, and anatomical abnormalities.
Summary:
- Mucosal prolapse is treatable with sclerosis (quinine-urea), avoiding cerclage, and addressing factors like rectal fixation and sacral curvature.
- Total prolapse, occurring in younger infants, may necessitate surgery due to irreducibility and has diverse causes including congenital abnormalities and innervation disorders.
- Predisposing factors for mucosal prolapse include prolonged straining, constipation/diarrhea, malnutrition, and prematurity.
Impact:
- Provides insights into the management of pediatric rectal prolapse, differentiating between types and their respective treatments.
- Underscores the role of socioeconomic factors, particularly nutrition, in the prevalence and severity of rectal prolapse.
- Contributes to understanding the complex etiology of rectal prolapse, including anatomical, neurological, and congenital factors.
Abstract:
Two different conditions are contrasted: mucosal prolapse in children aged between 2 and 5 years and total prolapse, which is very rare. Mucosal prolapse has become very rare in industrialised countries because of the excellent improvement in nutrition since the war, while this remains a very serious condition in under-developed countries. It is rapidly cured, provided the therapeutic errors are avoided, in particular cerclage. Sclerosis with quinine-urea is indicated in this situation. The various causes are discussed: in particular, the abnormal fixation of the rectum and the absence of the sacral curvature. The predisposing factors are essentially prolonged time spent on the pot, constipation and prolonged diarrhoea and, most importantly, malnutrition and prematurity. Total prolapse in very rare; it is about 15 centimetres long curved posteriorly and often incoercible. It occurs in younger infants and even neonates. It is often irreducible and therefore requires surgery in certain cases. It frequently disappears after the age of 8 years. There are a number of very different causes, not only malnutrition and prematurity and, in this clinical context, strain plays an important role and may be due to a vesical or urethral stone or to a congenital abnormality of these organs, but also abnormalities of the rectal segment with disorders of innervation, connective tissue diseases, any diseases affecting the internal sphincter, in particular congenital abnormalities. Abnormalities of the intrinsic rectal innervation with loss of sensitivity are frequent and can be due to denervations caused by a surgical operation (Hirschsprung's operation, for example). Abnormalities of the baso-receptors have also been observed.(ABSTRACT TRUNCATED AT 250 WORDS)