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Rectal prolapse

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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).


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)