1. RECTAL PROLAPSE: CLINICAL ASSESSMENT I J Adam Consultant Colorectal Surgeon Sheffield Teaching Hospitals NHS Trust M62 Coloproctology Course 7 th 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 Sigmoidoscopyrectal 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 approachyoung patients incontinence an issue

36. SUMMARY CLINICAL ASSESSMENT OF RECTAL PROLAPSE

37. Identification of rectal prolapse Pre-operative investigation of rectal prolapse

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

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