How is pediatric rectal prolapse classified?

Updated: Nov 12, 2018
  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Carmen Cuffari, MD  more...
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Answer

One classification of rectal prolapse divides the entity into true prolapse (protrusion of all layers of the rectum) and procidentia (herniation of only the mucosa). However, this classification is confusing and nonspecific and therefore, fallen out of use.

The most used classification for rectal prolapse was described in 1971 by Altemeier et al, who divided the entity into the following types [3] :

  • Type I - Protrusion of redundant mucosa, termed false prolapse; usually associated with hemorrhoids
  • Type II - Intussusception without sliding hernia of the cul-de-sac; it occupies the rectal ampulla but does not continue through the anal canal; the most common symptom is fecal incontinence, but solitary ulcers in the anterior rectal mucosa can be seen
  • Type III - Complete, full-thickness rectal wall prolapse, associated with a sliding hernia of the Douglas pouch. It is the most frequent type

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