Surgical Management of Rectal Prolapse in Infants and Children

Abstract

The surgical management of children with rectal prolapse is wide ranging and without consensus within the pediatric surgical community. While the majority of rectal prolapse in infants and children resolves spontaneously or with the medical management of constipation, a small but significant subset of patients may require intervention for persistent symptoms. In this review, we discuss the etiology and pathophysiology of rectal prolapse in both infants and children, options for medical management, described interventions and surgical options and their outcomes, and future avenues for research and investigation.

The Remission Effects of First Injection of Sclerotherapy for Pediatric Rectal Prolapse: A Systematic Review and Meta-Analysis

“…Some patients can resolve after conservative management, such as medical treatment for constipation. However, a subgroup of patients might need aggressive intervention due to persistent symptoms or the lack of spontaneous resolve ( 2 ). Therefore, when the clinicians make a clinical judgment, that is, whether they want to take a more aggressive management, sclerotherapy might be an intermediate choice between conservative treatment and surgery.…”

“…The inclusion criteria of this study were as follows: ( 1 ) Sclerotherapy treatment for pediatric patients with rectal prolapse; ( 2 ) The studies with sclerotherapy outcome and related clinical profiles; ( 3 ) The studies with detailed data of sclerotherapy and pediatric rectal prolapse; ( 4 ) These studies were also published in English language in the journals of science citation index database; and ( 5 ) Retrospective or prospective study. The exclusion criteria were the following: ( 1 ) Some parts of detailed data were unavailable in the content of the articles (unavailable even after inquiring the corresponding authors about the data needed for this meta-analysis); ( 2 ) The authors did not respond or could not have access to the dataset, in which case the articles would be excluded as the category without detailed data; ( 3 ) The studies that do not belong to patients with rectal prolapse or sclerotherapy; and ( 4 ) Review articles.…”

“…Most patients of pediatric rectal prolapse belong to the mucosal subtype, which is related to straining due to constipation during the toilet training process in children. Pediatric rectal prolapse in older children might be related to congenital neuromuscular abnormalities, autism or developmental delay, and anorectal malformations ( 2 , 3 ).…”

“…Spontaneous resolution would be around 60–90% in pediatric rectal prolapse. Compared to pediatric rectal prolapse, rectal prolapse in adults was rarely spontaneously resolving ( 2 ). Despite the high rate of spontaneous resolution, pediatric patients with rectal prolapse will suffer much if the condition will not spontaneously resolve.…”

Functional Constipation and Dyssynergic Defecation in Children

“…Rectal prolapse may develop as a consequence of prolonged straining in children with constipation. While in the majority of children, the rectal prolapse resolves spontaneously or as a consequence of medical management, a small but significant subset of patients may require surgery if the prolapse persists ( 65 ).…”