Morning Report: 3/19/2015

Today’s Morning Report is presented by Dr. Aldokhi!

 

 

My Butt Hurts (Procidentia)

 

Case: 79 year old female with abdominal pain

 

Definition  Full-thickness intussusception of the rectum through the anus
Epidemiology Bimodal age distribution (extreme of age)
Causes Children <3 increased abdominal pressure (constipation, chronic diarrhea)

–       Malnutrition, parasitic infection, or cystic fibrosis

–       Usually mucosal prolapse

Adult weak pelvic floor (elderly female, multiparty)

–       Cancer 4 folds than general population

–       Usually full thickness

S & S –       Mass after defecation

–       Incontinence (75%)

–       Spotting, mucus

–       Concentric rectal rings

Treatment

 

Children usually conservative (treat the cause)

Adult usually surgical

In ED:

–       Reduced with normal rectal exam -> Rx symptomatic with surgery follow up

–       Not reduced, try sugar with gentle pressure. If reduced discharge, if not surgery consult.

Complication Ulceration

Incarceration

Strangulation

Perforation (can happen during reduction)

Functional

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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