How is manual reduction performed in the treatment of pediatric rectal prolapse?

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

When the prolapse is present at the time of examination, reduction should be promptly performed before the onset of edema. Parents should have gloves and lubricant and should be taught how to reduce the prolapse at home.

The prolapsed bowel may be grasped with lubricated gloved fingers and pushed back in with gentle steady pressure. If the bowel has become edematous, firm steady pressure for several minutes may be necessary to reduce the swelling and allow reduction. Digital rectal examination should always follow this procedure to verify complete reduction. If the prolapse immediately recurs, it may be reduced again and the buttocks taped together for several hours.

Prompt reduction is critical. The prolapsed mucosa becomes edematous as a result of lymphatic obstruction. If the process is not reversed at this stage, venous obstruction ensues, aggravating the edema (see the image below) eventually leading to arterial obstruction with subsequent necrosis. Once the bowel becomes necrotic, emergency surgical resection is necessary. An acutely strangulated rectal prolapse should be covered with warm moist towels, and the patient should be brought to the emergency department immediately.

Picture of infant with full-thickness rectal prola Picture of infant with full-thickness rectal prolapse. Severe edema and abundant mucus are seen on mucosal surface.

When reduction is difficult due to edema, topical table sugar may be used as an osmotic aid to help decrease the edema and facilitate reduction, thereby obviating emergency surgical intervention. [44, 45] This allows the patient to be treated electively under stable conditions. [45] The sugar exerts a mild osmotic power over the prolapsed mucosa, helping the edema to slowly resolve, which permits a nontraumatic reduction and prevents complications.

Sugar does not irritate the mucosa like other substances (eg, salt). The author has used sugar to reduce edematous prolapsed bowel in 12 patients. The edema resolves by as much as 50% in 30-90 minutes. The entire prolapsed mucosa must be covered with sugar, and the process can be repeated up to 3 times. This also improves the microcirculation in the affected segment, making it more favorable for any surgical procedure.


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