Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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). +++ Absolute + • Presence of nonviable bowel or rupture of rectal mucosa.• Child appears toxic (ie, with fever, tachycardia, or leukocytosis). +++ Relative + • Uncooperative patient.• Questionable viability of bowel.• Mucosal ulceration.• Recent rectal pull-through procedure. + • Gloves.• Lubrication.• Table sugar or salt.• 6F rectal tube. + • 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. + • 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. ++Table Graphic Jump LocationTable 30–1. Classification of rectal prolapse.View Table||Download (.pdf)Table 30–1. Classification of rectal prolapse.CharacteristicsMucosal ProlapseFull-thickness Prolapse (Procidentia)Layers involvedMucosa onlyAll layers of the rectumPhysical appearanceRosette appearing with radial folds at anal junctionCircular folds in prolapsed mucosa May not be seen with significant edema + • Consider use of ketamine or midazolam. + • Have the patient lie supine in the Trendelenburg position on a padded surface.• Elevate ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.