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Case 73: Soiling

A 52 year old man complains of faecal incontinence. He has difficulty passing stool and finds that he needs to wear a pad. Occasionally he has noted blood and mucous on the pad. Colonoscopy is normal but whilst he is sedated you examine him further.

1. What does the photo show?

The rectal wall has been grasped with Babcock forceps to demonstrate full thickness circumferential rectal prolapse.

2. What are the management options?

Conservative measures include explanation of the problem to the patient as wells as dietary and toilet habit modification. Assessment of the patients fitness for surgery, their bowel habit and their sphincter integrity is essential when planning further treatment.

Operative intervention may be via either a perineal or an abdominal approach. Perineal options include rectal mucosal resection and plication of the muscle wall, a DeLorme's procedure, or a full thickness proctosigmoidectomy with anastomosis, an Altmeier procedure. Thiersch wire encircelment of the anus is no longer performed because of the high rate of sepsis and erosion.

Abdominal procedures include mesh rectopexy (Ripstein procedure) or sigmoidectomy with rectopexy which is useful for constipated patients. Rarely complete faecal diversion with colostomy may be required to manage faecal inconinence.

eMedicine --- Rectal Prolapse ---