A case of paediatric rectal prolapse without spontaneous reduction on arrival.

Aoki Y, Kitazawa K. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220608 Description Most cases of rectal prolapse in children are naturally reduced; thus, cases without spontaneous reduction are extremely uncommon. We report a girl (aged 2 years 8 months) with paediatric rectal prolapse without spontaneous reduction on arrival at the emergency department. Although the patient had not been diagnosed with any specific disease, she had a history of hard stools and difficulty defecating. Four days before arriving at the hospital, she began toilet training to stop using diapers. She came to the hospital at night with her parents who described ‘gut escaping from her anus’. On examination, she showed prolapse of the entire circumference of the rectum from the anus with mucosal bleeding (figure 1). Manipulative reduction was performed and she returned home, but the escape recurred several times. Considering her age and underlying constipation, we started outpatient management of constipation before referral to paediatric surgeon. At the time of surgical consultation, she no longer showed any recurrence. When rectal prolapse is present without spontaneous reduction, it must be reduced immediately because this may lead to difficulty in manipulative reduction due to congestion and oedema of mucosa. Although treatment is essentially conservative, cases with frequent recurrence or difficulty in manipulative reduction may require surgical intervention. Furthermore, it is said that children older than 4 years of age not responding to conservative treatment, without underlying conditions are the most important points to be aware of when consulting a paediatric surgeon. The most frequent cause of rectal prolapse in children is chronic constipation; thus, bowel management is important in rectal prolapse. Infrequently, some cases may require a biopsy, colonoscopy or sigmoidoscopy to investigate other underlying conditions.