QUIZ ON RECTAL PROLAPSE l скачать в хорошем качестве

QUIZ ON RECTAL PROLAPSE l

🎯Here are the important points about rectal prolapse relevant for exams, presented systematically: 1. Definition • Rectal prolapse refers to the protrusion of the full thickness of the rectal wall through the anus. 2. Etiology • Primary causes: • Chronic constipation. • Pelvic floor weakness. • Neurological disorders (e.g., spinal cord injury). • Multiple vaginal deliveries (in females). • Secondary causes: • Post-surgical complications. • Connective tissue disorders (e.g., Ehlers-Danlos syndrome). 3. Clinical Features • Visible prolapse, especially on straining. • Rectal bleeding or mucous discharge. • Fecal incontinence or obstructive defecation symptoms. • Sensation of a mass at the anal verge. 4. Classification • Partial prolapse: Mucosal layer only. • Complete prolapse: Full-thickness rectal wall. 5. Diagnosis • History: Focus on bowel habits, straining, incontinence. • Physical Examination: • Observe the prolapse during straining. • Digital rectal examination to exclude other pathologies. • Investigations: • Colonoscopy (rule out malignancy). • Defecography (dynamic imaging to confirm prolapse and assess other pelvic floor abnormalities). 6. Complications • Ulceration or ischemia of the prolapsed segment. • Strangulation and gangrene (rare). 7. Treatment Non-surgical: • Dietary modifications (high fiber). • Treat constipation. • Pelvic floor exercises (Kegels). Surgical: Surgery is the mainstay of treatment for complete prolapse: • Abdominal approach: • Rectopexy: Fixation of the rectum to the sacrum (mesh or suture-based). • Indicated for healthy patients. • Perineal approach (less invasive): • Delorme’s Procedure: Mucosal stripping and muscular plication for partial prolapse. • Altemeier’s Procedure: Perineal rectosigmoidectomy for elderly or high-risk patients. 8. Prognosis • Recurrence rates vary with procedure and patient factors. • Abdominal approaches generally have lower recurrence rates. 9. Key Exam Pearls • Always mention the difference between partial and complete prolapse. • Highlight the importance of treating underlying conditions like constipation. • Know indications and contraindications for abdominal vs. perineal approaches. • Emphasize the complications if left untreated.