The records of 28 patients with
rectal prolapse treated with injection
sclerotherapy over a 16-year period were reviewed. Initial management included assessment and correction of predisposing factors. If
rectal prolapse persisted or if the
prolapse required repeat emergency or operating room reduction, injection
sclerotherapy was performed. The
sclerosing agent included D50W in 21 patients (sole agent in 15, combined with
ethanolamine oleate in four, and with
phenol 5% in two).
Phenol 5% alone was used in six patients, and 25% saline was used in one patient. Number of
injections, recurrences, and complications were reviewed.
RESULTS: Two patients were lost to follow-up, and one patient was cured once a
polyp was recognized and removed. Of the remaining 25 patients, 21 were cured. Sixteen required one injection, three required two
injections, and two required three
injections (64% cure rate after one injection, 84% cure rate after three
injections). There were 4 of 25 failures: two went on to low anterior resection after having failed two
injections each; one patient was treated with Thiersch cerclage and injection after two failed
injections; and one patient did not respond after three
injections but had less severe
prolapses. Of those injected with D50W alone, 13 of 14 were cured with injection
sclerotherapy. Nine received one injection, two received two
injections, and two received three
injections (64% cure rate after one injection, 93% cure rate after three
injections). The only complication was excessive oozing at the injection site in one patient. He was simply observed in hospital overnight. Follow-up averaged 33 months. The only significant underlying abnormality in our patient population was
spina bifida in one patient. This patient was cured with injection
therapy.
Cystic fibrosis was ruled out by clinical examination and sweat
chloride test in all patients.
Constipation was the most common condition identified with the onset of
rectal prolapse (15 of 28).
CONCLUSIONS: Injection
sclerotherapy is simple and should be considered as the first line treatment of recurrent
rectal prolapse after failure of conservative measures. D50W is effective, easily available, inexpensive, and associated with few complications.