Injection Sclerotherapy for Rectal Prolapse in Children Using Video Endoscope Through a Clear Plastic Anoscope with Slots

Abstract

Introduction: Rectal prolapse denotes extrusion of some or all of the rectal mucosa through the external anal sphincter. Injection sclerotherapy using five percent phenol in almond oil is one of the modalities for treating rectal prolapse in children. We report here the technique of injection sclerotherapy under endoscopic vision using a clear plastic disposable anoscope (TriView anoscope) and sclerotherapy injector through the video sigmoidoscope. Methods: Prior to the sclerotherapy procedure, sigmoidoscopy was performed to rule out any concomitant lesions. A clear view plastic anoscope with three slots in the circumference along its long axis was then introduced and examination done using video sigmoidoscope. Rectal mucosa was found to project through three slots into the lumen, Anoscope was rotated along its longitudinal axis to confirm the bulging of mucosa in different positions and distinguish it from internal hemorrhoids. Five percent phenol in almond oil was injected in 0.5 ml aliquots at three bulging sites above the dentate line using 23 G standard sclerotherapy needle passed through the video sigmoidoscope. The anoscope was rotated to select new bulging sites and sclerotherapy repeated. Results: Five children with rectal prolapse were treated by sclerotherapy. Age ranged 3 to 12 years. The patients were followed every month. One patient developed hemorrhage on the 3rd post procedure day, which was managed conservatively. Prolapse ceased and bleeding per rectum did not recur in three children after the first session while two of them required two and three sessions. Conclusion: Injection sclerotherapy under direct endoscopic vision using TriView anoscope is simple and may be recommended for the treatment of rectal prolapse in children.Figure 1