Management of idiopathic rectal prolapse in children.

OBJECTIVE: To determine the percentage of patients of idiopathic rectal prolapse improving on spontaneously over the period of observation (phase I), and to determine the outcome of patients with rectal prolapse who received injection sclerotherapy (phase II).

DESIGN: Quasi-experimental study.

PLACE AND DURATION OF STUDY: National Institute of Child Health, Karachi from April 2001 to March 2002.

PATIENTS AND METHODS: The study was conducted in two phases. In phase I of the study, newly diagnosed patients of idiopathic rectal prolapse were followed without any treatment, till the spontaneous resolution of rectal prolapse. The time period at which 50% patients improved clinically was called 'time for spontaneous resolution 50%, (TSR 50%). In phase II, injection sclerotherapy (IST) was given to those patients whose prolapse was of more than three months duration. This was a separate cohort of patients.

RESULTS: One hundred patients were inducted in the study. They all had idiopathic rectal prolapse and their ages ranged from 6 months to 12 years with mean age of 5.30 +/- 2.30 years. In phase I, out of a total 50 patients, 40 could be followed with non-interventional strategy. In more than 50% of patients, the prolapse disappeared within 3 months. This was called TSR 50%. In phase II study, out of 50 patients who received IST, 29 improved within 2 weeks of single injection while 12 more improved with second injection within two months. Overall rate of resolution of prolapse at two months (41/50) was highly significant in comparison with proportion of improvement in phase I patients with p-value of 0.001. Four patients received third injection. At the end of three months prolapse disappeared in all patients of this phase (p-value < 0.0001). No complication related to injection occurred.

CONCLUSION: Both non-operative and injection sclerotherapy are effective in managing idiopathic rectal prolapse in paediatric population, but in terms of early recovery injection sclerotherapy is recommended as it is associated with less morbidity and is cost-effective.