RECTAL PROLAPSE: CLINICAL ASSESSMENT I J Adam Consultant Colorectal Surgeon Sheffield Teaching Hospitals NHS Trust M62 Coloproctology Course 7 th 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 Squat Strain on toilet
IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history Normal examination in left lateral Squat Strain 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 Sigmoidoscopyrectal neoplasms solitary rectal ulcer mucosal 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 theatre Investigate all patients
PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Denis, Ganansia & Puy-Montbrun Proctologie 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 approachyoung patients incontinence an issue
SUMMARY CLINICAL ASSESSMENT OF RECTAL PROLAPSE
Identification of rectal prolapse Pre-operative investigation of rectal prolapse
SUMMARY CLINICAL ASSESSMENT OF RECTAL PROLAPSE Identification of rectal prolapse Examination during squat or on toilet Defaecating proctogram Rectal biopsy
SUMMARY CLINICAL ASSESSMENT OF RECTAL PROLAPSE Pre-operative investigation of rectal prolapse Sigmoidoscopy for all patients Slow transit constipation Diarrhoea Younger patients with incontinence