Rectal prolapse is an eversion of several layers of the rectum through the anus caused by persistent straining because of urogenital or intestinal disease. The most common cause is severe enteritis/proctitis due to endoparasites, most often affecting kittens under 4 months of age. Additional causes would include foreign bodies, neoplasia of the rectum or distal colon, dystocia, or feline urologic syndrome, Manx cats are predisposed to this disease.
Rectal tissue is everted, swollen, and reddened, and accompanying ulceration or necrosis may be seen. The prolapse mass is cylindrical, with a depression seen in the end. Tenesmus and pain may or may not be present.
Rectal prolapse must be differentiated from ileocolic or colic intussusception. Grossly, they appear similar, but signs of partial or complete obstruction usually accompany intussusception. In addition, with rectal prolapse, a lubricated probe cannot be passed between the rectal wall and the prolapsed mass. This is in contradistinction to an intussusception.
The primary goal of treatment of rectal prolapse is to eliminate the underlying cause while alleviating the immediate discomfort. If the prolapse is mild, of short duration, and the tissue is healthy in appearance, then a conservative approach is recommended. A warm isotonic solution is applied to the exposed mucosa.
The mucosa should be gently manipulated and massaged in an attempt to remove edema from the prolapsed segment. The prolapse is then gently reduced following the application of a water-soluble lubricant to its surface. A loose pursestring suture is placed in the anus. The cat is fed a low-residue diet and treated with stool softener. The pursestring suture should be removed in 7 to 10 days. The cat should then remain on stool softeners for another 2 to 3 weeks.
If conservative management fails, a colopexy is recommended. This technique fixes the colon to the abdominal wall using six to eight mattress sutures in the hope that this will reduce the tendency for recurrence. A 3- or 4-0 nonabsorbable suture material is used and is placed partial thickness through the wall of the colon and fixed to the abdominal wall 3 to 4 cm to the left of the midline abdominal incisions
Amputation of the prolapsed rectum is necessary if, on initial presentation, the rectal mucosa is necrotic, lacerated, or irreducible. Excision of the prolapsed portion is followed by a full-thickness anastomosis of the remaining rectal segments." Careful placement of sutures to incorporate all mucosal and serosal layers is important. The cat is given only liquids for 48 hours following surgery, then is returned to a normal diet and treated with a stool softener for 2 to 3 weeks. Because of the possibility of strictures, incontinence, or leakage from the anastomotic site following amputation, more conservative methods of treating a rectal prolapse are encouraged. Prognosis with these more conservative methods is fair to good.
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