Prolapsed mass that tricked many
One year old boy was referred to KATH paediatric surgery team from a district hospital with recurrent rectal prolapse for the past one month. Child has been experiencing this condition resulting in several hospital visits. On each ocassion the mass was reduced and the patient discharged home. The presentation was also associated with recurrent abdominal distension, vomiting, poor feeding and weight loss. There was passage of blood streaked stool s on some ocassion
Examination : Ill looking malnourished child, sausage shapped mass in the infraumbilical region.
Rectal exams revealed an obvious pink mass with concentric folds consistent with small bowel of about 16cm protruding from the anus. Bowel looked viable but slightly oedematous. Examining finger could be advanced btween rectal wall and bowel.
Diagnosis: Prolapsed intussusception
Investigations : FBC, BUN, CREAT, Electrolytes
Mass was reduced to protect bowel mucosa from dehydration. After a failed pneumatic reduction, exploratory laparotomy was done.
Findings : Ileocolic intussusception which was manually reduced
Post operative : Child mad excellent recovery was able to feed and improved nutritionally before being discharged home
Discussion : Child was seen at several hospitals and misdiagnosed for rectal prolapse. A more thorough digital examination was the only difference that would contributed to a correct diagnosis and hence appropriate managment. In a rectal prolapse which commonly seen in children the examining finger cannot be advanced between thge rectal wall and the prolapsed mass because the prolapsed mass is continous with the anal skin.
Credits : Dr Michael Amoah (paediatric surgeon), Dr Opuni ( Senior Resident , Padiatric surgery ), Department of paediatric surgery, KATH