rectal prolapse: clinical assessment i j adam consultant colorectal surgeon sheffield teaching...
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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
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