Rectal prolapse in children. Causes, diagnostics, treatment (a literature review)


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Introduction. Rectal prolapse is evagination of the rectal wall outside the anal opening. It can be full-thickness, partial thickness or mucosal. Rectal prolapse is most often met in children from 1 to 4 years of age. This is due to their anatomical features: vertical position of the rectum (open anorectal angle), mobile sigmoid colon, increased mobility of the rectal mucous. Chronic constipation plays an important role in evagination as well as infection, parasitic diseases and cystic fibrosis.

Material and methods. Literature searches were done in Scopus, PubMed, Google Scolar and eLibrary databases.

Results. Diagnostics includes disease history and physical examination. It is important to differentiate rectal prolapse from hemorrhoids and prolapsing rectal polyps. Photos taken by parents at the moment of prolapse can benefit in making a rapid and correct diagnosis as at the moment of examination the prolapse has very often been corrected. Currently, there are three basic approaches for rectal prolapse care: conservative, sclerotherapy and surgical. The conservative treatment is aimed to reduce the prolapse and to treat the basic disease. Sclerotherapy is the injection of the preparation which causes local inflammation and fibrosis. The injection is made into the pararectal space. If the conservative treatment is ineffective and the patient suffers of frequent prolapses, strangulation, mucous bleedings, than surgical treatment may be indicated for children older than 4.

Conclusion. The meta-analysis, performed recently, has demonstrated that conservative treatment is recommended for children before 4 because spontaneous prolapse correction is often seen in this age group. 70% ethyl alcohol is very effective as the sclerosant. Surgical interventions in case of the rectal prolapse are various; open and laparoscopic rectopexy is considered the most effective one. In some cases, rectum fixation with mesh is indicated. Currently, there is no any technique for rectal prolapse treatment which could guarantee no recurrences. Curative tactics is always individual.

作者简介

E. Pimenova

I.M. Sechenov First Moscow State Medical University

编辑信件的主要联系方式.
Email: evgeniyapimenova@list.ru
ORCID iD: 0000-0001-7206-5987

Eugeniya S. Pimenova, MD, associate professor at department of pediatric surgery and urology-andrology 

Moscow, 119991

俄罗斯联邦

G. Korolev

I.M. Sechenov First Moscow State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0001-5730-3684

Moscow, 119991

俄罗斯联邦

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