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Background <p>Idiopathic rectal prolapse is one of the most common conditions that can affect infants and young children. It is a self limiting disorder in the majority of cases. Treatment starts usually by conservative management, but if it fails, physicians search for more effective methods for treatment such as sclerotherapy or surgical intervention. 15% hypertonic saline is one of the safe, cost effective and technically available sclerosants that could be injected, but it has a relatively high recurrence rate. Anal Cerclage is one of the most popular procedures used as a primary intervention method for rectal prolapse being simple and minimally invasive. We believe that combination of both techniques in the same setting has a higher success rate.</p> Objectives <p>The aim of this study was to describe the outcome of injection sclerotherapy with 15% hypertonic saline in combination with anal cerclage in patients with idiopathic partial rectal prolapse.</p> Patients and method <p>This is a prospective clinical trial study on pediatric patients who presented with idiopathic partial rectal prolapse to outpatient clinic of Cairo University specialized pediatric Hospital.</p> <p>We enrolled 40 children with idiopathic partial rectal prolapse, in whom conservative management failed, including 24 males and 16 females (M: F 1:0.6). Data were collected for12 months from January 2023 till January 2024.The mean duration of rectal prolapse was 14.4 ± 4.04&#xa0;months. Under GA 15% hypertonic saline was injected submucosally at 4 anal quadrants avoiding anterior anal aspects. Then Cerclage was done by a round needle with absorbable Vicryl suture to help keeping rectal mucosa in place for few days till the effect of the injected sclerosants starts. Results were analyzed through SPSS 21.</p> Results <p>In 95% of cases, resolution of prolapse occurred with single session of sclerotherapy-circulage combined approach. 5% rectal prolapse needed two sessions of sclerotherapy-circulage combined approach. Two patients developed perianal inflammation which resolved with conservative management. There was no recurrence in any patient on follow-up of at least 6&#xa0;months.</p> Conclusion <p>Injection of 15% hypertonic saline is safe, easy to inject, cost effective sclerosing agent which could be prepared in hospital pharmacy. We found that combination of injection sclerotherapy with anal cerclage has a 100% success rate with up to two sessions of injections. This combined technique can be safely chosen as a proper management for idiopathic rectal prolapse in children.</p>

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Effect of concomitant use of hypertonic saline injection with anal cerclage for treatment of idiopathic partial rectal prolapse in children: a double hit therapy

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  • 发表日期：

    2025年7月9日

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  • Belal elezaby,
  • Ahmed Arafat,
  • wesam mahmoud,
  • Sherif Kaddah,
  • Mostafa Gad

摘要

Background

Idiopathic rectal prolapse is one of the most common conditions that can affect infants and young children. It is a self limiting disorder in the majority of cases. Treatment starts usually by conservative management, but if it fails, physicians search for more effective methods for treatment such as sclerotherapy or surgical intervention. 15% hypertonic saline is one of the safe, cost effective and technically available sclerosants that could be injected, but it has a relatively high recurrence rate. Anal Cerclage is one of the most popular procedures used as a primary intervention method for rectal prolapse being simple and minimally invasive. We believe that combination of both techniques in the same setting has a higher success rate.

Objectives

The aim of this study was to describe the outcome of injection sclerotherapy with 15% hypertonic saline in combination with anal cerclage in patients with idiopathic partial rectal prolapse.

Patients and method

This is a prospective clinical trial study on pediatric patients who presented with idiopathic partial rectal prolapse to outpatient clinic of Cairo University specialized pediatric Hospital.

We enrolled 40 children with idiopathic partial rectal prolapse, in whom conservative management failed, including 24 males and 16 females (M: F 1:0.6). Data were collected for12 months from January 2023 till January 2024.The mean duration of rectal prolapse was 14.4 ± 4.04 months. Under GA 15% hypertonic saline was injected submucosally at 4 anal quadrants avoiding anterior anal aspects. Then Cerclage was done by a round needle with absorbable Vicryl suture to help keeping rectal mucosa in place for few days till the effect of the injected sclerosants starts. Results were analyzed through SPSS 21.

Results

In 95% of cases, resolution of prolapse occurred with single session of sclerotherapy-circulage combined approach. 5% rectal prolapse needed two sessions of sclerotherapy-circulage combined approach. Two patients developed perianal inflammation which resolved with conservative management. There was no recurrence in any patient on follow-up of at least 6 months.

Conclusion

Injection of 15% hypertonic saline is safe, easy to inject, cost effective sclerosing agent which could be prepared in hospital pharmacy. We found that combination of injection sclerotherapy with anal cerclage has a 100% success rate with up to two sessions of injections. This combined technique can be safely chosen as a proper management for idiopathic rectal prolapse in children.