Outcomes and complications of trans-anal sclerotherapy in children with rectal prolapse in Tabriz pediatric hospital

Abstract

Rectal prolapse is relatively common in children with a maximum incidence in 1-3 years. Most cases of rectal prolapse in children have no underlying cause and are idiopathic. Nevertheless, anatomical and infectious causes also play a role. Less invasive methods are being developed due to their lower complications and better productivity, especially in children, where the recovery time after open surgery should be minimized. This study aimed to evaluate the results and complications of anal transrectal sclerotherapy in children with rectal prolapse in a pediatric hospital. Materials and Methods: In this clinical trial, 20 patients in the intervention group and 20 patients in the control group of patients with rectal prolapse who were referred to Tabriz Children's Hospital from March 2021 to March 2022 were included. After general anesthesia in the lithotomy position, first, the anus and rectum are examined with the finger and the speculum and then in three places at 3, 6, and 9 o'clock (1 cc/kg at 6 o'clock and 0.5 cc/kg at h 3 and 9) 50% dextrose was injected subcutaneously 2-3 cm above the toothed line. After regaining consciousness, the patient was discharged and visited one week later for early complications, and then the patients were followed up for recurrence and complications for two quarters and six months. Control group were on supportive treatment such as control of constipation and prolapse underlying condition and patients without constipation (such as stool relaxer) were in follow-up for 6 months. Results: The mean age of patients in the intervention group was 62.5 years and in the control group was 15.15 years. Most patients were male in terms of gender distribution (77.5%). The mean onset of symptoms in patients in the intervention group was 22.60±9.73 months and in the control group was 24.10±9.34 months. All patients had grade III and IV rectal prolapse. The most common symptom was partial rectal detachment (45%). At the first visit, 90% of patients had a normal examination, and only 10% had edema at the injection site. Only one patient had cellulite at the second examination (one week later). At a three-month follow-up visit for medium-term complications, one case of anus stenosis and two cases of re-injection were observed. The final visit of patients related to long-term complications included two recurrences of prolapse.