Northwell, Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA.
Curr Gastroenterol Rep. 2025 Dec;27(1):6. doi: 10.1007/s11894-024-00953-5. Epub 2024 Nov 23.
Rectal prolapse in the pediatric population presents a clinical challenge with wide variability in etiology, presentation, work-up and management. In this article, we reviewed the evidence supporting various medical and surgical treatment options as well as the recent trends amongst pediatric surgeons.
Medical therapy is highly effective in most patients, with bowel management programs being particularly successful. Nonetheless, medically refractory disease, often seen in older children and in children with behavioral/psychiatric disorders, can be challenging. Sclerotherapy with ethanol or 5% phenol can be effective local treatments. 15% hypertonic saline, 50% dextrose, and Deflux are additional safe alternatives. Perianal procedures and perineal procedures are less invasive surgical options, but transabdominal rectopexy appears to be the favored treatment for disease refractory to local treatment. Transabdominal rectopexy with sigmoidectomy, the recommended operation in the adult population for patients with prolapse and constipation, appears only to be preferred in the pediatric population for postoperative recurrences.
While outcomes of medical treatment for pediatric rectal prolapse are excellent, sclerotherapy and transabdominal rectopexy are effective options for refractory disease preferred by most pediatric surgeons.
小儿直肠脱垂的病因、表现、检查和处理方式存在广泛差异，给临床带来挑战。本文就支持各种治疗方法的证据以及小儿外科医生的最新趋势进行综述。
大多数患者对内科治疗反应良好，肠道管理方案尤其有效。然而，在大龄儿童和伴有行为/精神障碍的儿童中，经常会出现内科治疗无效的情况，处理起来颇具挑战。乙醇或 5%苯酚硬化疗法可作为有效的局部治疗方法。15%高渗盐水、50%葡萄糖和 Deflux 是另外两种安全的替代方法。肛周手术和会阴手术是侵袭性较小的手术选择，但对于局部治疗无效的疾病，经腹直肠固定术似乎是首选治疗方法。经腹直肠固定术联合乙状结肠切除术，即成人直肠脱垂伴便秘的推荐手术，似乎仅在儿科人群中，因术后复发而被首选。
尽管内科治疗小儿直肠脱垂的效果极好，但硬化疗法和经腹直肠固定术对大多数小儿外科医生来说，是治疗无效疾病的有效方法。
