Download PDF
Clin Colon Rectal Surg 2018; 31(02): 108-116
DOI: 10.1055/s-0037-1609025
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pediatric Rectal Prolapse

Rebecca M. Rentea
1   Deparment of Surgery, Children's Mercy Hospital, Kansas City, Missouri
,
Shawn D. St Peter
1   Deparment of Surgery, Children's Mercy Hospital, Kansas City, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
25 February 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Rectal prolapse is a common and self-limiting condition in infancy and early childhood. Most cases respond to conservative management. Patients younger than 4 years with an associated condition have a better prognosis. Patients older than 4 years require surgery more often than younger children. Multiple operative and procedural approaches to rectal prolapse exist with variable recurrence rates and without a clearly superior operation. These include sclerotherapy, Thiersch's anal cerclage, Ekehorn's rectopexy, laparoscopic suture rectopexy, and posterior sagittal rectopexy.

Keywords

rectal prolapse - pediatric - sclerotherapy - surgery - rectopexy
 

  • References

  • 1 Chan WK, Kay SM, Laberge JM, Gallucci JG, Bensoussan AL, Yazbeck S. Injection sclerotherapy in the treatment of rectal prolapse in infants and children. J Pediatr Surg 1998; 33 (02) 255-258
    CrossrefPubMedSearch in Google Scholar
  • 2 Dutta BN, Das AK. Treatment of prolapse rectum in children with injections of sclerosing agents. J Indian Med Assoc 1977; 69 (12) 275-276
    PubMedSearch in Google Scholar
  • 3 Narasanagi SS. Rectal prolapse in children. J Indian Med Assoc 1974; 62 (11) 378-380
    PubMedSearch in Google Scholar
  • 4 Eriksen CA, Hadley GP. Rectal prolapse in childhood--the role of infections and infestations. S Afr Med J 1985; 68 (11) 790-791
    PubMedSearch in Google Scholar
  • 5 Zempsky WT, Rosenstein BJ. The cause of rectal prolapse in children. Am J Dis Child 1988; 142 (03) 338-339
    PubMedSearch in Google Scholar
  • 6 Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr (Phila) 1999; 38 (02) 63-72
    CrossrefPubMedSearch in Google Scholar
  • 7 Duhamel J, Pernin P. [Anal prolapse in the child]. Ann Gastroenterol Hepatol (Paris) 1985; 21 (06) 361-362
    PubMedSearch in Google Scholar
  • 8 Freeman NV. Rectal prolapse in children. J R Soc Med 1984; 77 (Suppl. 03) 9-12
    PubMedSearch in Google Scholar
  • 9 Ripstein CB, Lanter B. Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg 1963; 157: 259-264
    CrossrefPubMedSearch in Google Scholar
  • 10 Severijnen R, Festen C, van der Staak F, Rieu P. Rectal prolapse in children. Neth J Surg 1989; 41 (06) 149-151
    PubMedSearch in Google Scholar
  • 11 Chino ES, Thomas Jr CG. Transsacral approach to repair of rectal prolapse in children. Am Surg 1984; 50 (02) 70-75
    PubMedSearch in Google Scholar
  • 12 Suzuki H, Amano S, Matsumoto K, Tsukamoto Y. Anorectal motility in children with complete rectal prolapse. Prog Pediatr Surg 1989; 24: 105-114
    PubMedSearch in Google Scholar
  • 13 Corman ML. Rectal prolapse in children. Dis Colon Rectum 1985; 28 (07) 535-539
    CrossrefPubMedSearch in Google Scholar
  • 14 Philip AT, Marraffa JM. Death following injection sclerotherapy due to phenol toxicity. J Forensic Sci 2012; 57 (05) 1372-1375
    CrossrefPubMedSearch in Google Scholar
  • 15 Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse. Surg Clin North Am 1997; 77 (01) 49-70
    CrossrefPubMedSearch in Google Scholar
  • 16 Kopel FB. Gastrointestinal manifestations of cystic fibrosis. Gastroenterology 1972; 62 (03) 483-491
    PubMedSearch in Google Scholar
  • 17 Stern RC, Izant Jr RJ, Boat TF, Wood RE, Matthews LW, Doershuk CF. Treatment and prognosis of rectal prolapse in cystic fibrosis. Gastroenterology 1982; 82 (04) 707-710
    PubMedSearch in Google Scholar
  • 18 Antao B, Bradley V, Roberts JP, Shawis R. Management of rectal prolapse in children. Dis Colon Rectum 2005; 48 (08) 1620-1625
    CrossrefPubMedSearch in Google Scholar
  • 19 Akkoyun I, Akbiyik F, Soylu SG. The use of digital photos and video images taken by a parent in the diagnosis of anal swelling and anal protrusions in children with normal physical examination. J Pediatr Surg 2011; 46 (11) 2132-2134
    CrossrefPubMedSearch in Google Scholar
  • 20 White CM, Findlay JM, Price JJ. The occult rectal prolapse syndrome. Br J Surg 1980; 67 (07) 528-530
    CrossrefPubMedSearch in Google Scholar
  • 21 Alexander-Williams J. Solitary-ulcer syndrome of the rectum. Its association with occult rectal prolapse. Lancet 1977; 1 (8004): 170-171
    PubMedSearch in Google Scholar
  • 22 El-Chammas KI, Rumman N, Goh VL, Quintero D, Goday PS. Rectal prolapse and cystic fibrosis. J Pediatr Gastroenterol Nutr 2015; 60 (01) 110-112
    CrossrefPubMedSearch in Google Scholar
  • 23 Robertson MB, Choe KA, Joseph PM. Review of the abdominal manifestations of cystic fibrosis in the adult patient. Radiographics 2006; 26 (03) 679-690
    CrossrefPubMedSearch in Google Scholar
  • 24 Abeş M, Sarihan H. Injection sclerotherapy of rectal prolapse in children with 15 percent saline solution. Eur J Pediatr Surg 2004; 14 (02) 100-102
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Koivusalo AI, Pakarinen MP, Rintala RJ. Rectopexy for paediatric rectal prolapse: good outcomes but not without postoperative problems. Pediatr Surg Int 2014; 30 (08) 839-845
    CrossrefPubMedSearch in Google Scholar
  • 26 Zhang SC, Wang WL, Liu X. Defecography used as a screening entry for identifying evacuatory pelvic floor disorders in childhood constipation. Clin Imaging 2014; 38 (02) 115-121
    CrossrefPubMedSearch in Google Scholar
  • 27 Koivusalo AI, Pakarinen MP, Rintala RI, Seuri R. Dynamic defecography in the diagnosis of paediatric rectal prolapse and related disorders. Pediatr Surg Int 2012; 28 (08) 815-820
    CrossrefPubMedSearch in Google Scholar
  • 28 Chen R, Zhao H, Sang X, Mao Y, Lu X, Yang Y. Severe adult ileosigmoid intussusception prolapsing from the rectum: a case report. Cases J 2008; 1 (01) 198
    CrossrefPubMedSearch in Google Scholar
  • 29 Khushbakht S, ul Haq A. Rectal duplication cyst: a rare cause of rectal prolapse in a toddler. J Coll Physicians Surg Pak 2015; 25 (12) 909-910
    PubMedSearch in Google Scholar
  • 30 Mönig SP, Selzner M, Schmitz-Rixen T. Peutz-Jeghers syndrome in a child. Prolapse of a large colonic polyp through the anus. J Clin Gastroenterol 1997; 25 (04) 703-704
    CrossrefPubMedSearch in Google Scholar
  • 31 Coburn III WM, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med 1997; 30 (03) 347-349
    CrossrefPubMedSearch in Google Scholar
  • 32 Qvist N, Rasmussen L, Klaaborg KE, Hansen LP, Pedersen SA. Rectal prolapse in infancy: conservative versus operative treatment. J Pediatr Surg 1986; 21 (10) 887-888
    CrossrefPubMedSearch in Google Scholar
  • 33 Bahador A, Foroutan HR, Hosseini SM, Davani SZ. Effect of submucosal alcohol injection on prolonged rectal prolapse in infants and children. J Indian Assoc Pediatr Surg 2008; 13 (01) 11-13
    CrossrefPubMedSearch in Google Scholar
  • 34 Sander S, Vural O, Unal M. Management of rectal prolapse in children: Ekehorn's rectosacropexy. Pediatr Surg Int 1999; 15 (02) 111-114
    CrossrefPubMedSearch in Google Scholar
  • 35 Hill SR, Ehrlich PF, Felt B, Dore-Stites D, Erickson K, Teitelbaum DH. Rectal prolapse in older children associated with behavioral and psychiatric disorders. Pediatr Surg Int 2015; 31 (08) 719-724
    CrossrefPubMedSearch in Google Scholar
  • 36 Johansen OB, Wexner SD, Daniel N, Nogueras JJ, Jagelman DG. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum 1993; 36 (08) 767-772
    CrossrefPubMedSearch in Google Scholar
  • 37 Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 2008; (04) CD001758
    PubMedSearch in Google Scholar
  • 38 Ismail M, Gabr K, Shalaby R. Laparoscopic management of persistent complete rectal prolapse in children. J Pediatr Surg 2010; 45 (03) 533-539
    CrossrefPubMedSearch in Google Scholar
  • 39 Flum AS, Golladay ES, Teitelbaum DH. Recurrent rectal prolapse following primary surgical treatment. Pediatr Surg Int 2010; 26 (04) 427-431
    CrossrefPubMedSearch in Google Scholar
  • 40 Gabriel WB. Thiersch's operation for anal incontinence and minor degrees of rectal prolapse. Am J Surg 1953; 86 (05) 583-590
    CrossrefPubMedSearch in Google Scholar
  • 41 Oeconomopoulos CT, Swenson O. Thiersch's operation for rectal prolapse in infants and children. Am J Surg 1960; 100: 457-461
    CrossrefPubMedSearch in Google Scholar
  • 42 Ashcraft KW, Garred JL, Holder TM, Amoury RA, Sharp RJ, Murphy JP. Rectal prolapse: 17-year experience with the posterior repair and suspension. J Pediatr Surg 1990; 25 (09) 992-994 , discussion 994–995
    CrossrefPubMedSearch in Google Scholar
  • 43 Henry LG, Cattey RP. Rectal prolapse. Surg Laparosc Endosc 1994; 4 (05) 357-360
    PubMedSearch in Google Scholar
  • 44 Green D. Mechanism of action of sclerotherapy. Semin Dermatol 1993; 12 (02) 88-97
    PubMedSearch in Google Scholar
  • 45 Beck DE. Rectal prolapse: an update. Curr Surg 2000; 57 (03) 185-189
    CrossrefPubMedSearch in Google Scholar
  • 46 Wyllie GG. The injection treatment of rectal prolapse. J Pediatr Surg 1979; 14 (01) 62-64
    CrossrefPubMedSearch in Google Scholar
  • 47 Fahmy MA, Ezzelarab S. Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children. Pediatr Surg Int 2004; 20 (05) 353-356
    CrossrefPubMedSearch in Google Scholar
  • 48 Gysler R, Morger R. Sclerosing treatment with ethoxysclerol in anal prolapse in children [in German]. Z Kinderchir 1989; 44 (05) 304-305
    PubMedSearch in Google Scholar
  • 49 Kay NR, Zachary RB. The treatment of rectal prolapse in children with injections of 30 per cent saline solutions. J Pediatr Surg 1970; 5 (03) 334-337
    CrossrefPubMedSearch in Google Scholar
  • 50 Malyshev YI, Gulin VA. Our experience with the treatment of rectal prolapse in infants and children. Am J Proctol 1973; 24 (06) 470-472
    PubMedSearch in Google Scholar
  • 51 Shah A, Parikh D, Jawaheer G, Gornall P. Persistent rectal prolapse in children: sclerotherapy and surgical management. Pediatr Surg Int 2005; 21 (04) 270-273
    CrossrefPubMedSearch in Google Scholar
  • 52 Saleem MM, Al-Momani H. Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child. BMC Surg 2006; 6: 19
    CrossrefPubMedSearch in Google Scholar
  • 53 Schepens MA, Verhelst AA. Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children. J Pediatr Surg 1993; 28 (11) 1494-1497
    CrossrefPubMedSearch in Google Scholar
  • 54 Balde I, Mbumbe-King A, Vinand P. [The Lockhart-Mummery technique in the treatment of the total rectal prolapse among children. Concerning 25 cases (author's transl)]. Chir Pediatr 1979; 20 (05) 375-377
    PubMedSearch in Google Scholar
  • 55 Nazem M, Hosseinpour M, Farhadi M. Perineal mesh rectopexy with sterile talc in children with rectal prolapse. Eur J Pediatr Surg 2010; 20 (05) 321-324
    Thieme ConnectPubMedSearch in Google Scholar
  • 56 Senagore AJ. Management of rectal prolapse: the role of laparoscopic approaches. Semin Laparosc Surg 2003; 10 (04) 197-202
    PubMedSearch in Google Scholar
  • 57 Boccasanta P, Rosati R, Venturi M. , et al. Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse: clinical and functional results. Surg Laparosc Endosc 1998; 8 (06) 460-465
    CrossrefPubMedSearch in Google Scholar
  • 58 Boccasanta P, Venturi M, Reitano MC. , et al. Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse. Dig Surg 1999; 16 (05) 415-419
    CrossrefPubMedSearch in Google Scholar
  • 59 Heah SM, Hartley JE, Hurley J, Duthie GS, Monson JR. Laparoscopic suture rectopexy without resection is effective treatment for full-thickness rectal prolapse. Dis Colon Rectum 2000; 43 (05) 638-643
    CrossrefPubMedSearch in Google Scholar
  • 60 Lechaux D, Trebuchet G, Siproudhis L, Campion JP. Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome. Surg Endosc 2005; 19 (04) 514-518
    CrossrefPubMedSearch in Google Scholar
  • 61 Xynos E, Chrysos E, Tsiaoussis J, Epanomeritakis E, Vassilakis JS. Resection rectopexy for rectal prolapse. The laparoscopic approach. Surg Endosc 1999; 13 (09) 862-864
    CrossrefPubMedSearch in Google Scholar
  • 62 Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg 2005; 140 (01) 63-73
    CrossrefPubMedSearch in Google Scholar
  • 63 Koivusalo A, Pakarinen M, Rintala R. Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: a preliminary report. Surg Endosc 2006; 20 (06) 960-963
    CrossrefPubMedSearch in Google Scholar
  • 64 Laituri CA, Garey CL, Fraser JD. , et al. 15-Year experience in the treatment of rectal prolapse in children. J Pediatr Surg 2010; 45 (08) 1607-1609
    CrossrefPubMedSearch in Google Scholar
  • 65 Potter DD, Bruny JL, Allshouse MJ, Narkewicz MR, Soden JS, Partrick DA. Laparoscopic suture rectopexy for full-thickness anorectal prolapse in children: an effective outpatient procedure. J Pediatr Surg 2010; 45 (10) 2103-2107
    CrossrefPubMedSearch in Google Scholar
  • 66 Saxena AK, Metzelder ML, Willital GH. Laparoscopic suture rectopexy for rectal prolapse in a 22-month-old child. Surg Laparosc Endosc Percutan Tech 2004; 14 (01) 33-34
    PubMedSearch in Google Scholar
  • 67 Köhler A, Athanasiadis S. The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse--a clinical and manometric study. Langenbecks Arch Surg 2001; 386 (03) 188-192
    CrossrefPubMedSearch in Google Scholar
  • 68 Tsugawa C, Matsumoto Y, Nishijima E, Muraji T, Higashimoto Y. Posterior plication of the rectum for rectal prolapse in children. J Pediatr Surg 1995; 30 (05) 692-693
    CrossrefPubMedSearch in Google Scholar
  • 69 Lasheen AE. Closed rectosacropexy for rectal prolapse in children. Surg Today 2003; 33 (08) 642-644
    CrossrefPubMedSearch in Google Scholar
  • 70 Montes-Tapia F, Cura-Esquivel I, Garza-Luna U, Martínez-Flores G, Muñoz-Maldonado G, Abrego-Moya V. Sigmoid fixation associated with rectopexy using a laparoscopic approach could prevent relapse of rectal prolapse in pediatric patients with spinal dysraphia. J Pediatr Surg 2008; 43 (08) 1551-1553
    CrossrefPubMedSearch in Google Scholar
  • 71 Puri B. Rectal prolapse in children: laparoscopic suture rectopexy is a suitable alternative. J Indian Assoc Pediatr Surg 2010; 15 (02) 47-49
    CrossrefPubMedSearch in Google Scholar
  • 72 Brown AJ, Anderson JH, McKee RF, Finlay IG. Strategy for selection of type of operation for rectal prolapse based on clinical criteria. Dis Colon Rectum 2004; 47 (01) 103-107
    CrossrefPubMedSearch in Google Scholar
  • 73 Kariv Y, Delaney CP, Casillas S. , et al. Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc 2006; 20 (01) 35-42
    CrossrefPubMedSearch in Google Scholar
  • 74 Demirbas S, Akin ML, Kalemoglu M, Ogün I, Celenk T. Comparison of laparoscopic and open surgery for total rectal prolapse. Surg Today 2005; 35 (06) 446-452
    CrossrefPubMedSearch in Google Scholar
  • 75 Fengler SA, Pearl RK, Prasad ML. , et al. Management of recurrent rectal prolapse. Dis Colon Rectum 1997; 40 (07) 832-834
    CrossrefPubMedSearch in Google Scholar
  • 76 Peña A, Hong A. The posterior sagittal trans-sphincteric and trans-rectal approaches. Tech Coloproctol 2003; 7 (01) 35-44
    CrossrefPubMedSearch in Google Scholar
  • 77 Ashcraft KW, Amoury RA, Holder TM. Levator repair and posterior suspension for rectal prolapse. J Pediatr Surg 1977; 12 (02) 241-245
    CrossrefPubMedSearch in Google Scholar
  • 78 Davidian Jr VA, Thomas Jr CG. Trans-sacral repair of rectal prolapse. Efficacy of treatment in thirty consecutive patients. Am J Surg 1972; 123 (02) 231-235
    CrossrefPubMedSearch in Google Scholar
  • 79 Sarin YK, Sharma AK. Posterior sagittal rectopexy for rectal prolapse. Indian Pediatr 1993; 30 (04) 541-542
    PubMedSearch in Google Scholar
  • 80 Pearl RH, Ein SH, Churchill B. Posterior sagittal anorectoplasty for pediatric recurrent rectal prolapse. J Pediatr Surg 1989; 24 (10) 1100-1102
    CrossrefPubMedSearch in Google Scholar
  • 81 Momoh JT. Quadrant mucosal stripping and muscle pleating in the management of childhood rectal prolapse. J Pediatr Surg 1986; 21 (01) 36-38
    CrossrefPubMedSearch in Google Scholar
  • 82 Hight DW, Hertzler JH, Philippart AI, Benson CD. Linear cauterization for the treatment of rectal prolapse in infants and children. Surg Gynecol Obstet 1982; 154 (03) 400-402
    PubMedSearch in Google Scholar
  • 83 Chwals WJ, Brennan LP, Weitzman JJ, Woolley MM. Transanal mucosal sleeve resection for the treatment of rectal prolapse in children. J Pediatr Surg 1990; 25 (07) 715-718
    CrossrefPubMedSearch in Google Scholar
  • 84 Lee JI, Vogel AM, Suchar AM, Glynn L, Statter MB, Liu DC. Sequential linear stapling technique for perineal resection of intractable pediatric rectal prolapse. Am Surg 2006; 72 (12) 1212-1215
    PubMedSearch in Google Scholar
  • 85 Chaloner EJ, Duckett J, Lewin J. Paediatric rectal prolapse in Rwanda. J R Soc Med 1996; 89 (12) 688-689
    CrossrefPubMedSearch in Google Scholar
  • 86 Godbole P, Botterill I, Newell SJ, Sagar PM, Stringer MD. Solitary rectal ulcer syndrome in children. J R Coll Surg Edinb 2000; 45 (06) 411-414
    PubMedSearch in Google Scholar
  • 87 Felt-Bersma RJ, Tiersma ES, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele. Gastroenterol Clin North Am 2008; 37 (03) 645-668 , ix
    CrossrefPubMedSearch in Google Scholar
  • 88 Harris PR, Figueroa-Colon R. Rectal prolapse in children associated with Clostridium difficile infection. Pediatr Infect Dis J 1995; 14 (01) 78-80
    CrossrefPubMedSearch in Google Scholar
  • 89 Lopez EL, Devoto S, Fayad A, Canepa C, Morrow AL, Cleary TG. Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome. J Pediatr 1992; 120 (2, Pt 1): 210-215
    CrossrefPubMedSearch in Google Scholar