Dynamic defecography in the diagnosis of paediatric rectal prolapse and related disorders.
OBJECTIVE
Paediatric rectal prolapse (RP) is rarely a diagnostic problem and resolves often spontaneously. We studied whether the assessment of recurrent RP (RP), postoperative relapsed RP (RRP) or anorectal discomfort without RP (ARD) benefits from dynamic defecography (DD) and describe DD findings in relation with outcome.


METHODS
Fifteen patients (7 males), median age of 10 (range 3.7-15) years, underwent 19 DD with a synchronic small bowel contrast study. Indications for DD were RP (n = 11), RD (n = 3) and RRP (n = 1). Three patients had solitary rectal ulcer and one juvenile rectal polyps (n = 1). Three patients underwent a total of four postoperative DD because of suspected relapse.


RESULTS
In 11 patients with a clinically diagnosed prolapse DD displayed a simple prolapse (n = 3), prolapse with enterocele (n = 1), prolapse with small bowel interposition (n = 1), rectal intussusception with anterior rectocele (n = 1) and rectal intussusception (n = 1) and no pathology (n = 4) (37 %). In four patients with ARD DD displayed rectal prolapse originating from sigmoid intussusception (n = 1), enterocele (n = 1) and anterior rectocele (n = 1) and no pathology in one. Median follow-up was 8.1(range 3.0-44) months. Ten patients underwent surgery. Three patients with RP underwent simple laparoscopic rectopexy, five with RP or RD with enterocele or anterior rectocele had rectopexy with anterior peritoneoplasty and two (RP n = 1, RRP n = 1) with sigmoid intussusception had sigmoid resection with rectopexy. Two symptomatic patients (RP, negative DD) are scheduled for rectopexy. Three patients PPRP (n = 2) RD (n = 1) had spontaneous cure. Postoperative DD confirmed relapsed RP in one patient.


CONCLUSIONS
In patients, RP and associated disorders' DD can disclose significant pathology (enterocele, rectocele or sigmoid intussusception) and thereby guide surgical treatment, and should be included in the pre-treatment assessment.
Children's Hospital, University of Helsinki, Stenbackinkatu 11, 00290, LNS HUS PL 281, Finland. antti.koivusalo@hus.fi
A I
AI
Koivusalo
M P
MP
Pakarinen
R I
RI
Rintala
R
R
Seuri
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019841:Defecography / Q000379:methods; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D012005:Rectal Prolapse / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D020047:Rectocele / Q000150:complications; D012008:Recurrence; D012189:Retrospective Studies