We present a 2year old boy who presented with a recurrent pink mass per rectum. Mass had become irreducible within past one week. Patient was seen and referred to the teaching hospital in the region, KATH. Parents refused to go to the hospital due to financial difficulties. They resorted to use of topical application of herbs to the prolapsed mass.
Patient was seen at the general OPD by a house officer. He had been erroneously diagnosed as rectal prolapse.
Wasted, dehydrated, ill looking , febrile, lethargic
Temp 38 degrees Celcius
Chest clear, heart sound regular and tachycardic
Abdomen was soft with firm mass in left iliac fossa
Rectal exams revealed a fried sausage shaped mass at the anus. Finger could be insinuated between mass and rectal wall. Areas of dessicated mucosa were present
Blood counts showed a marked elevation of white cells . Haemoglobin was within normal range
Rescuscitation was commmenced with iv R/L 20ml/kg bolus and repeated 3 times. Maintence of DNS set up.
Iv antibiotics : metronidazole 15mg/kg st then 7.5mg tds, Ciprofluoxacin 10mg/kg tds
Prolapsed bowel irrigated with normal saline and covered with sterile gauze
Decision taken to perform laparotomy . Parents consented.
Anesthesia : conscious sedation
Left lower quadrant abdominal incision was used to gainaccess to abdomen . Intussusception peritonealised by reducing via rectum
Bowel milked and inspected. Bowel integrity accessed to be normal. Routine closure of abdomen done
Post operative period
Patient had fever and diarrhoea for about a week but resolved between the 8 and 10th day. Bile acid induced perineal excoriation was treated with silver sulphadiazine. He was discharged home without any extra complications
Prolapsed intussusception can be misdiagnosed as prolapsed rectum . It leads to dehydration and malnutrition in most patients. A simple distinguishing feature is that with prolapsed intussusception, the examining finger can be insinuated between the prolapsed bowel and rectal wall. This can’t be done for rectal prolapse hence the distinction.
Dr Ametih, PA Jeffery