Rectal prolapse pathophysiology: Difference between revisions
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{{CMG}}; {{AE}}{{SHH}} | {{CMG}}; {{AE}}{{SHH}} | ||
==Overview== | ==Overview== | ||
Rectal prolapse starts from rectal [[intussusception]], followed by external mucosal prolapse, and eventually a full protrusion of all layers of the rectum. Rectal prolapse is associated with several coexisting anatomic abnormalities including diastasis of the levator ani, abnormally deep cul-de-sac and redundant [[sigmoid colon]]. | Rectal prolapse starts from rectal [[intussusception]], followed by external [[Mucous membrane|mucosal]] prolapse, and eventually a full protrusion of all layers of the rectum. Rectal prolapse is associated with several coexisting [[Anatomy|anatomic]] abnormalities including [[diastasis]] of the [[levator ani]], abnormally deep cul-de-sac and redundant [[sigmoid colon]]. | ||
==Pathophysiology== | ==Pathophysiology== | ||
===Pathogenesis=== | ===Pathogenesis=== | ||
The evolution of rectal prolapse starts from excessive straining over time that leads to the weakness of pelvic floor muscles and connective tissue injury (including nerve injury and [[neuropathy]] of the pelvic floor). These lead to rectal [[intussusception]] initially, followed by external mucosal prolapse, and eventually a full protrusion of all layers of the rectal wall through the anus.<ref name="pmid29050194">{{cite journal |vauthors=Patcharatrakul T, Rao SSC |title=Update on the Pathophysiology and Management of Anorectal Disorders |journal=Gut Liver |volume= |issue= |pages= |year=2017 |pmid=29050194 |doi=10.5009/gnl17172 |url=}}</ref> | The evolution of rectal prolapse starts from excessive straining over time that leads to the weakness of [[pelvic floor]] muscles and [[connective tissue]] injury (including [[nerve injury]] and [[neuropathy]] of the [[pelvic floor]]). These lead to rectal [[intussusception]] initially, followed by external [[Mucous membrane|mucosal]] prolapse, and eventually a full protrusion of all layers of the rectal wall through the [[anus]].<ref name="pmid29050194">{{cite journal |vauthors=Patcharatrakul T, Rao SSC |title=Update on the Pathophysiology and Management of Anorectal Disorders |journal=Gut Liver |volume= |issue= |pages= |year=2017 |pmid=29050194 |doi=10.5009/gnl17172 |url=}}</ref> | ||
The shearing forces exerted by the passage of flatus or fecal matter push and pull the obstructing mucosal folds, thereby gradually involving and progressively traumatizing the deeper layers of the rectal wall and initiating a vicious circle of obstruction and prolapse formation.<ref name="pmid27599704">{{cite journal |vauthors=Kraemer M, Paulus W, Kara D, Mankewitz S, Rozsnoki S |title=Rectal prolapse traumatizes rectal neuromuscular microstructure explaining persistent rectal dysfunction |journal=Int J Colorectal Dis |volume=31 |issue=12 |pages=1855–1861 |year=2016 |pmid=27599704 |pmc=5116046 |doi=10.1007/s00384-016-2649-8 |url=}}</ref> | The shearing forces exerted by the passage of flatus or fecal matter push and pull the obstructing mucosal folds, thereby gradually involving and progressively traumatizing the deeper layers of the rectal wall and initiating a vicious circle of obstruction and prolapse formation.<ref name="pmid27599704">{{cite journal |vauthors=Kraemer M, Paulus W, Kara D, Mankewitz S, Rozsnoki S |title=Rectal prolapse traumatizes rectal neuromuscular microstructure explaining persistent rectal dysfunction |journal=Int J Colorectal Dis |volume=31 |issue=12 |pages=1855–1861 |year=2016 |pmid=27599704 |pmc=5116046 |doi=10.1007/s00384-016-2649-8 |url=}}</ref> | ||
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Rectal prolapse is associated with several coexisting anatomic abnormalities:<ref name="pmid28991074">{{cite journal |vauthors=Bordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL, Steele SR |title=Clinical Practice Guidelines for the Treatment of Rectal Prolapse |journal=Dis. Colon Rectum |volume=60 |issue=11 |pages=1121–1131 |year=2017 |pmid=28991074 |doi=10.1097/DCR.0000000000000889 |url=}}</ref><ref name="pmid22379404">{{cite journal |vauthors=Goldstein SD, Maxwell PJ |title=Rectal prolapse |journal=Clin Colon Rectal Surg |volume=24 |issue=1 |pages=39–45 |year=2011 |pmid=22379404 |pmc=3140332 |doi=10.1055/s-0031-1272822 |url=}}</ref> | Rectal prolapse is associated with several coexisting anatomic abnormalities:<ref name="pmid28991074">{{cite journal |vauthors=Bordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL, Steele SR |title=Clinical Practice Guidelines for the Treatment of Rectal Prolapse |journal=Dis. Colon Rectum |volume=60 |issue=11 |pages=1121–1131 |year=2017 |pmid=28991074 |doi=10.1097/DCR.0000000000000889 |url=}}</ref><ref name="pmid22379404">{{cite journal |vauthors=Goldstein SD, Maxwell PJ |title=Rectal prolapse |journal=Clin Colon Rectal Surg |volume=24 |issue=1 |pages=39–45 |year=2011 |pmid=22379404 |pmc=3140332 |doi=10.1055/s-0031-1272822 |url=}}</ref> | ||
*[[Diastasis]] of the levator ani | *[[Diastasis]] of the levator ani | ||
*Abnormally deep cul-de-sac of Douglas | *Abnormally deep cul-de-sac of [[Rectouterine pouch|Douglas]] | ||
*Redundant [[sigmoid colon]] | *Redundant [[sigmoid colon]] | ||
*Patulous anal sphincter | *Patulous anal sphincter | ||
*Loss or attenuation of the rectal sacral attachments | *Loss or attenuation of the rectal sacral attachments | ||
== Gross Pathology == | |||
The gross pathology of rectal prolapse includes: | |||
[[File:Rectal Prolapse Toddler 1.jpg|1000px|center|thumb|'''Rectal Prolapse''' <br> Source: Wikimedia commons- By BellaVuk <ref name="urlFile:Rectal Prolapse Toddler 1.jpg - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/wiki/File%3ARectal_Prolapse_Toddler_1.jpg |title=File:Rectal Prolapse Toddler 1.jpg - Wikimedia Commons |format= |work= |accessdate=}}</ref>]] | |||
==References== | ==References== | ||
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[[Category:Medicine]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 20:36, 26 February 2018
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Rectal prolapse Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Rectal prolapse pathophysiology On the Web |
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American Roentgen Ray Society Images of Rectal prolapse pathophysiology |
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Risk calculators and risk factors for Rectal prolapse pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2]
Overview
Rectal prolapse starts from rectal intussusception, followed by external mucosal prolapse, and eventually a full protrusion of all layers of the rectum. Rectal prolapse is associated with several coexisting anatomic abnormalities including diastasis of the levator ani, abnormally deep cul-de-sac and redundant sigmoid colon.
Pathophysiology
Pathogenesis
The evolution of rectal prolapse starts from excessive straining over time that leads to the weakness of pelvic floor muscles and connective tissue injury (including nerve injury and neuropathy of the pelvic floor). These lead to rectal intussusception initially, followed by external mucosal prolapse, and eventually a full protrusion of all layers of the rectal wall through the anus.[1]
The shearing forces exerted by the passage of flatus or fecal matter push and pull the obstructing mucosal folds, thereby gradually involving and progressively traumatizing the deeper layers of the rectal wall and initiating a vicious circle of obstruction and prolapse formation.[2]
Associated Conditions
Rectal prolapse is associated with several coexisting anatomic abnormalities:[3][4]
- Diastasis of the levator ani
- Abnormally deep cul-de-sac of Douglas
- Redundant sigmoid colon
- Patulous anal sphincter
- Loss or attenuation of the rectal sacral attachments
Gross Pathology
The gross pathology of rectal prolapse includes:
Source: Wikimedia commons- By BellaVuk [5]
References
- ↑ Patcharatrakul T, Rao S (2017). "Update on the Pathophysiology and Management of Anorectal Disorders". Gut Liver. doi:10.5009/gnl17172. PMID 29050194. Vancouver style error: initials (help)
- ↑ Kraemer M, Paulus W, Kara D, Mankewitz S, Rozsnoki S (2016). "Rectal prolapse traumatizes rectal neuromuscular microstructure explaining persistent rectal dysfunction". Int J Colorectal Dis. 31 (12): 1855–1861. doi:10.1007/s00384-016-2649-8. PMC 5116046. PMID 27599704.
- ↑ Bordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL, Steele SR (2017). "Clinical Practice Guidelines for the Treatment of Rectal Prolapse". Dis. Colon Rectum. 60 (11): 1121–1131. doi:10.1097/DCR.0000000000000889. PMID 28991074.
- ↑ Goldstein SD, Maxwell PJ (2011). "Rectal prolapse". Clin Colon Rectal Surg. 24 (1): 39–45. doi:10.1055/s-0031-1272822. PMC 3140332. PMID 22379404.
- ↑ "File:Rectal Prolapse Toddler 1.jpg - Wikimedia Commons".
