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Rectal prolapse

Key sources
The following summarized guidelines for the evaluation and management of rectal prolapse are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2021), the American College of Radiology (ACR 2021), and the American Society of Colon and Rectal Surgeons (ASCRS 2017).
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Guidelines

1.Diagnostic investigations

Clinical history and physical examination: elicit a complete history and perform a physical examination, focusing on signs and symptoms of rectal prolapse, on anal sphincter structure and function, and underlying conditions.
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  • Laboratory testing

  • Anal physiologic testing

  • Diagnostic imaging

2.Medical management

Conservative management: as per WSES 2021 guidelines, consider attempting conservative measures and gentle manual reduction under mild sedation or anesthesia in patients with incarcerated rectal prolapse without signs of ischemia or perforation.
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  • Antibiotics

3.Surgical interventions

Timing for surgery: avoid delaying surgery in order to attempt a conservative management in hemodynamically unstable patients with complicated rectal prolapse.
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  • Choice of surgical approach

  • Abdominal approaches (posterior dissection)

  • Abdominal approaches (posterior rectopexy)

  • Abdominal approaches (posterior mesh rectopexy)

  • Abdominal approaches (ventral rectopexy)

  • Perineal approaches (mucosal sleeve resection)

  • Perineal approaches (perineal rectosigmoidectomy)