الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 77 |  |  |
| | | from | 77 | | |
Abstract
Rectal prolapse in children is a common condition that affects both healthy and diseased children. Although regarded a minor problem by most surgeons, yet very troublesome to children and their parents. Although a multifactorial etiology is the commonest, yet persistent straining with chronic constipation is implicated in most cases.
This work is a study of 12 consecutive cases of complete persistent rectal prolapse in infancy and childhood filtered from a total of 65 cases presented to our Pediatric Surgery Department, Alexandria University which did not respond to conservative measures on outpatient basis. The duration of the study was approximately 1 year from July 2015 to July 2016.
In our study, female patients outnumbered male patients. Out of our 12 cases 4 were males and 8 were females with a male to female ratio 1:2.
The age of incidence of our cases ranged from 6 months to 9 years with a mean of 3.32 years. Half of our cases (50%) were below the age of 3 years.
The mean duration of symptoms prior to presentation was 7 months. This ranged from 2 months to 2 years.
The presenting symptoms in primary cases were: mass bulging per rectum in 12 cases (100%), bleeding per rectum in 4 cases (33.3%), solitary rectal ulcer in 1 case (8.3%), chronic constipation in 3 cases (25%), straining in 6 cases (50%), and recurrence after previous surgical correction in 4 cases (33.3%) and none with incontinence.
Associated comorbidities were found in secondary cases. Ectopia vesicae was present in 3 cases (25%) and urinary bladder stones in one case (8.3%), otherwise, the remaining 8 cases (66.7%) were healthy children.
Conservative measures were tried first on all 65 cases at first encounter. It proved effective in controlling prolapse in 50 cases (76.9%) during the conservative treatment period of 3 months. The remaining 15 cases who failed to respond to conservative measures were essentially full-thickness variety and all of them were candidates for surgical repair. Out of which, 3 patients were not suitable for laparoscopic repair, so they underwent open rectosigmoidopexy and were excluded from the study. The remaining 12 cases were candidates for laparoscopic surgery: 8 cases (66.7%) were grade III and 4 cases (33.3%) were grade II.
All 12 cases were subjected to laparoscopic rectopexy and sigmoidopexy as the definitive line for treatment. The mean operative time was 58.42 minutes. No intraoperative complications were reported. The median post-operative hospital stay was 2.50 days.
A total of 11 cases (91.7%) were successfully controlled. One case showed initial improvement then mucosal prolapse which improved over 6 weeks by conservative measures in the form of sitz bath, oral laxatives and anti-inflammatory drugs.
Correction of the prolapse also helped in controlling the associated symptoms: bleeding completely disappeared, improvement of constipation was noticed during the outpatient visits and the post-operative barium enema showed no bowel dilation, no bowel kink and no residual dye indicating no delayed bowel emptying.
Morbidity after surgical management was mild. Only one case (8.3%) was complicated by skin stitch sinus at the site of sigmoid fixation suture to the anterior abdominal wall which was treated by removal of the suture and topical antibiotic cream