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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