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Most children experience resolution of idiopathic pediatric rectal prolapse with bowel management alone

  • Scott S. Short
    Correspondence
    Corresponding author.
    Affiliations
    Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
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  • Elisabeth K. Wynne
    Affiliations
    Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
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  • Sarah Zobell
    Affiliations
    Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
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  • Katherine Gaddis
    Affiliations
    Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
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  • Michael D. Rollins
    Affiliations
    Department of Surgery, Division of Pediatric Surgery and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States
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Published:November 24, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.11.003

      Abstract

      Background

      Recent studies in children with idiopathic rectal prolapse report up to 48% require surgical intervention to manage refractory disease. We sought to examine outcomes of our non-surgical approach to managing rectal prolapse using a bowel management program.

      Methods

      A retrospective review was performed for all children with the diagnosis of rectal prolapse between 2011 and 2020. Children with a rectal polyp or hemorrhoid were excluded.

      Results

      47 children with rectal prolapse were identified (median age at diagnosis of 4 years (IQR 3,7.75); age ≤ 4 years n = 30; age > 4 years n = 17). Associated diagnoses included constipation (n = 45, 96%) and psychiatric diagnoses (n = 7, 14%). Children underwent a bowel management program including stimulant laxatives in 44 (94%) and osmotic laxatives in 2 (4%). Median follow-up time was 181 days (IQR 77, 238). Median time to resolution of rectal prolapse was 9 months (IQR 4, 13) with a maximum time to resolution of 31 months. We compared children ≤ 4 years old (Group A) to those > 4 years old (Group B). Psychiatric diagnoses were less common in Group A (3.5 vs. 38.9%, p = 0.003). Median time to spontaneous resolution was 6.5 months (IQR 3.5, 9.5) in Group A versus 13.5 (IQR 4, 16) months in Group B, p = 0.13. No differences in surgical intervention were identified. Three (6.4%) patients required surgery for prolapse.

      Conclusions

      A bowel management program is an effective treatment for most children with rectal prolapse. This data suggests that surgical intervention is unnecessary in most children.

      Level of evidence

      III.

      Keywords

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