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RECTAL PROLAPSE: CLINICAL ASSESSMENT

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  1. RECTAL PROLAPSE:CLINICAL ASSESSMENT I J Adam Consultant Colorectal Surgeon Sheffield Teaching Hospitals NHS Trust M62 Coloproctology Course 7th April 2005

  2. CLINICAL ASSESSMENT 1. Identification of rectal prolapse 2. Pre-operative investigation of rectal prolapse

  3. IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history No clear prolapse history Uncertainty about what is prolapsing

  4. IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history

  5. IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history

  6. IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history Normal examination in left lateral

  7. IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history Normal examination in left lateral Squat

  8. IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history Normal examination in left lateral Squat Strain on toilet

  9. IDENTIFICATION OF RECTAL PROLAPSE Clear prolapse history Normal examination in left lateral Squat Strain on toilet

  10. IDENTIFICATION OF RECTAL PROLAPSE No clear prolapse history

  11. IDENTIFICATION OF RECTAL PROLAPSE No clear prolapse history Incontinence Difficult evacuation Bloody mucous discharge

  12. IDENTIFICATION OF RECTAL PROLAPSE No clear prolapse history Incontinence

  13. IDENTIFICATION OF RECTAL PROLAPSE No clear prolapse history Incontinence

  14. IDENTIFICATION OF RECTAL PROLAPSE No clear prolapse history Incontinence

  15. IDENTIFICATION OF RECTAL PROLAPSE No clear prolapse history Difficult evacuation

  16. IDENTIFICATION OF RECTAL PROLAPSE No clear prolapse history Bloody mucous discharge

  17. IDENTIFICATION OF RECTAL PROLAPSE Uncertainty about what is prolapsing

  18. IDENTIFICATION OF RECTAL PROLAPSE Uncertainty about what is prolapsing Circumferential mucosal prolapse

  19. IDENTIFICATION OF RECTAL PROLAPSE Uncertainty about what is prolapsing Circumferential mucosal prolapse

  20. IDENTIFICATION OF RECTAL PROLAPSE Uncertainty about what is prolapsing Circumferential mucosal prolapse

  21. CLINICAL ASSESSMENT 1. Identification of rectal prolapse 2. Pre-operative investigation of rectal prolapse

  22. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Sigmoidoscopy

  23. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Sigmoidoscopy rectal neoplasms solitary rectal ulcer mucosal inflammation

  24. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Is a sigmoidoscopy enough?

  25. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Is a sigmoidoscopy enough? Controversial area Straight to theatre Investigate all patients

  26. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Denis, Ganansia & Puy-Montbrun Proctologie Pratique Selective investigations based on clinical features

  27. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Constipation Diarrhoea Incontinence

  28. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Constipation

  29. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Constipation Slow Transit Constipation

  30. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Diarrhoea

  31. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Diarrhoea Infection

  32. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Diarrhoea Bowel investigations

  33. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Incontinence

  34. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Incontinence

  35. PRE-OPERATIVE INVESTIGATION OF RECTAL PROLAPSE PATIENTS Incontinence Selective approach young patients incontinence an issue

  36. SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE

  37. SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE Identification of rectal prolapse Pre-operative investigation of rectal prolapse

  38. SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE Identification of rectal prolapse Examination during squat or on toilet Defaecating proctogram Rectal biopsy

  39. SUMMARYCLINICAL ASSESSMENT OF RECTAL PROLAPSE Pre-operative investigation of rectal prolapse Sigmoidoscopy for all patients Slow transit constipation Diarrhoea Younger patients with incontinence