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  • • Most cases of rectal prolapse reduce spontaneously.

    • Rarely, a surgical procedure may be necessary to correct a full-thickness prolapse.

    • Rectal prolapse should be promptly reduced to prevent a sustained prolapse that allows edema to form and potential subsequent venous congestion and thrombosis to develop, which may lead to ulceration of the rectal mucosa with bowel ischemia and infarction.

    • A rectal examination needs to be performed to differentiate prolapse from an intussusception or rectal polyp.

    • Diagnostic studies are often not necessary, but a proctoscopy, colonoscopy, or barium enema may be indicated when the patient has a history of rectal bleeding.

    • Children need to be tested for parasites and cystic fibrosis as well as other causes of anal straining (including neuromuscular problems, proctitis, and inflammatory bowel disease).

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Absolute

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  • • Presence of nonviable bowel or rupture of rectal mucosa.

    • Child appears toxic (ie, with fever, tachycardia, or leukocytosis).

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Relative

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  • • Uncooperative patient.

    • Questionable viability of bowel.

    • Mucosal ulceration.

    • Recent rectal pull-through procedure.

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  • • Gloves.

    • Lubrication.

    • Table sugar or salt.

    • 6F rectal tube.

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  • • There are very few risks with manual reduction.

    • Parents should be informed that prolapse may recur and instructed on proper technique for reduction.

    • Discuss the potential risk of sedative medication.

    • Recurrent prolapse or a prolapse that is not amenable to manual reduction may require operative intervention.

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  • • Rectal prolapse commonly presents in children between the ages of 1 and 3 years, with a primary symptom of anal discomfort or prolapse after defecation; occasionally it may present as bleeding.

    • When a prolapse is not immediately present and the child is old enough to cooperate, diagnosis can potentially be made with the child squatting or straining on the toilet.

    • A glycerine suppository may also aid in the diagnosis.

    • Palpate the prolapsed segment between the fingers and thumb to help differentiate mucosa from full-thickness prolapse.

    • Mucosal prolapse tends to have radial folds and full-thickness prolapse exhibits concentric folds (Table 30–1).

    • Differentiate from polyp, which is plum-colored and does not involve the entire anal circumference.

    • Differentiate from intussusception, which on digital examination allows the examiner to insert between the anal wall and the protruding mass. With a prolapse, there is no space between the perianal skin and the protruding mass.

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Table Graphic Jump Location
Table 30–1. Classification of rectal prolapse. 
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  • • Consider use of ketamine or midazolam.

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  • • Have the patient lie supine in the Trendelenburg position on a padded surface.

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