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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Article info
Publication history
Published online: November 24, 2021
Accepted:
November 5,
2021
Received in revised form:
October 24,
2021
Received:
September 23,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
