Prolapse Of The Rectum

Once prolapsed, the blood supply becomes compromised and affected tissue will swell, become congested, oedematous and eventually necrotic. Without intervention there is a risk of peritonitis and death. Occasional cases may be seen in the livestock export process.

Small, recent rectal prolapses with little swelling may be reduced manually under caudal epidural anaesthesia (to reduce straining), and using soapy water or lubricant to help with replacement. Insert a loose, anal purse-string suture to prevent recurrence while leaving a two finger opening to allow passage of faeces. Remove after one week by which time swelling will have disappeared if the underlying condition has been corrected. 

If the prolapse is irreducible because of necrosis, size, or trauma, then submucosal resection or amputation should be attempted. Submucosal resection is preferred to amputation because there is less risk of rectal stricture. A field amputation method involving poly- or PVC pipe (about 2.5 cm in diameter) has been used effectively on export vessels (Manefield GW, Control and Therapy article number 4770, 2007). The pipe is inserted into the prolapsed rectum and rubber bands or suture material applied over the prolapse to form a tight ligature against the pipe, with the ligature placed close to the anal sphincter. The animal will defecate through the pipe during healing. At the site of the ligature, healthy proximal tissue will anastamose and the tissue distal to the ligature will necrose and fall away with the pipe after a week or so. A set of three different diameter pieces of pipe can be carried on board in case prolapses occur. 

Alternative approaches to amputation have also been described. One approach involves placing a series of U-sutures around the base of the prolapse. A 23 cm Gerlach needle carrying two 30 cm lengths of heavy-duty absorbable suture (sutures 1 and 2) is inserted into the lumen of the prolapse and the prolapsed tissue penetrated from the inside to the outside. The Gerlach needle is then used to carry the inner end of suture 2 and a new suture 3 from the lumen to the outside about 3 cm from the first penetration. Suturing continues in this manner for the circumference of the prolapse until there is a series of U-sutures around the prolapse. Each suture is tightened and tied, then the prolapse excised about 2 cm distal to the sutures. No haemorrhage occurs due to the ligation of the tissues. Spontaneous retraction of the stump occurs.

Simultaneously treat any underlying cause such as pneumonia, urolithiasis or diarrhoea. Prompt euthanasia is recommended if the prolapse cannot be corrected or amputated.