RECTAL PROLAPSE:

CLINICAL ASSESSMENT

I J AdamConsultant Colorectal Surgeon

Sheffield Teaching Hospitals NHS Trust

M62 Coloproctology Course 7th April 2005

CLINICAL ASSESSMENT

1. Identification of rectal prolapse

2. Pre-operative investigation of rectal prolapse

IDENTIFICATION OF RECTAL PROLAPSE

Clear prolapse history

No clear prolapse history

Uncertainty about what is prolapsing

IDENTIFICATION OF RECTAL PROLAPSE

Clear prolapse history

IDENTIFICATION OF RECTAL PROLAPSE

Clear prolapse history

IDENTIFICATION OF RECTAL PROLAPSE

Clear prolapse history

Normal examination in left lateral

IDENTIFICATION OF RECTAL PROLAPSE

Clear prolapse history

Normal examination in left lateral

Squat

IDENTIFICATION OF RECTAL PROLAPSE

Clear prolapse history

Normal examination in left lateral

SquatStrain on toilet

IDENTIFICATION OF RECTAL PROLAPSE

Clear prolapse history

Normal examination in left lateral

SquatStrain on toilet

IDENTIFICATION OF RECTAL PROLAPSE

No clear prolapse history

IDENTIFICATION OF RECTAL PROLAPSE

No clear prolapse history

Incontinence

Difficult evacuation

Bloody mucous discharge

IDENTIFICATION OF RECTAL PROLAPSE

No clear prolapse history

Incontinence

IDENTIFICATION OF RECTAL PROLAPSE

No clear prolapse history

Incontinence

IDENTIFICATION OF RECTAL PROLAPSE

No clear prolapse history

Incontinence

IDENTIFICATION OF RECTAL PROLAPSE

No clear prolapse history

Difficult evacuation

IDENTIFICATION OF RECTAL PROLAPSE

No clear prolapse history

Bloody mucous discharge

IDENTIFICATION OF RECTAL PROLAPSE

Uncertainty about what is prolapsing

IDENTIFICATION OF RECTAL PROLAPSE

Uncertainty about what is prolapsing

Circumferential mucosal prolapse

IDENTIFICATION OF RECTAL PROLAPSE

Uncertainty about what is prolapsing

Circumferential mucosal prolapse

IDENTIFICATION OF RECTAL PROLAPSE

Uncertainty about what is prolapsing

Circumferential mucosal prolapse

CLINICAL ASSESSMENT

1. Identification of rectal prolapse

2. Pre-operative investigation of rectal prolapse

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Sigmoidoscopy

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Sigmoidoscopy rectal neoplasmssolitary rectal ulcermucosal inflammation

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Is a sigmoidoscopy enough?

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Is a sigmoidoscopy enough?

Controversial area

Straight to theatreInvestigate all patients

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Denis, Ganansia & Puy-MontbrunProctologie Pratique

Selective investigations based on clinical features

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Constipation

Diarrhoea

Incontinence

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Constipation

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Constipation

Slow Transit Constipation

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Diarrhoea

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Diarrhoea

Infection

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Diarrhoea

Bowel investigations

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Incontinence

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Incontinence

PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS

Incontinence

Selective approach young patientsincontinence an issue

SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE

SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE

Identification of rectal prolapsePre-operative investigation of rectal prolapse

SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE

Identification of rectal prolapse

Examination during squat or on toilet

Defaecating proctogramRectal biopsy

SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE

Pre-operative investigation of rectal prolapse

Sigmoidoscopy for all patients

Slow transit constipationDiarrhoea

Younger patients with incontinence