Intussusception is the commonest cause of intestinal obstruction in childhood, with late presentation contributing significantly to morbidity and mortality. Prolapsed intussusception, also known as trans-anal protrusion of intussusception (TAPI), refers to protrusion of the head of the intus-susceptum through the anus.rectal prolapse refers to the protrusion of part or whole of the rectal wall through the external anal sphincter. It often begins as an extrusion of the mucosa at the muco-cutaneous junction (mucosal prolapse). It may progress to a full thickness prolapse, which is also termed as complete prolapse or procidentia.
An 8- month-old female infant with a diagnosis of rectal prolapse and severe dehydration. She had presented with a 1 day history of a mass protruding from the anus, that was “unsuccessfully reduced”. In the preceding 3 weeks, she had 4 other episodes of ‘prolapse’ with “successful” reductions. The initial episode was precipitated by non-bloody diarrhea. She had been weaned at 5 months and consumed cow milk in addition to breastfeeding.She was severely dehydrated and anemic.Her heart rate was 180 beats per minute. Her abdomen was distended, and a sausage-shaped mass was palpated in her left lower quadrant. A grossly edematous mass was protruding through the anus, with cyanotic hues on most parts. Her perineum and upper thigh had skin excoriations. An examining index finger that was inserted between the prolapsing anal mass and the wall of the rectum could not reach the apex of the sulcus.
Laboratory investigations revealed leukocytosis of 20,280/μL, he-moglobin of 8.9 g/dl and thrombocytosis of 612,000/μL. Electrolyte abnormalities were also noted with hypokalemia, hyponatremia and hypochloremia of 2.59, 122 and 85.1 mmol/L respectively.
A laparotomy was done via a transverse supra-umbilical (classical) incision. Technical challenges were encountered as reduction of the protruding anal mass into the abdomen was attempted unsuccessfully, prompting resection of the gut from the anal region followed by reduction. Since it was an ileo-colic intussusception with unviable terminal ileum, caecum, ascending colon and part of the transverse colon (Fig. 2), an end-to-end single layer ileo-transverse anastomosis was done using Vicryl® 3.0. Operative recovery was steady, on intravenous fluids, antibiotics and analgesics. Breastfeeding was commenced after 48 hours. She was dis-charged on the 10th post operative day. 2 weeks later. She had recovered fully
Conclusively, prolapsed intussusception is a differential diagnosis that should be considered in every child who presents with rectal prolapse. Differentiating TAPI from other prolapsing conditions is of paramount importance, as TAPI is associated with a higher mortality and morbidity. Prolapsing rectal polyps are uncommon in infants and are associated with rectal bleeding.
In order to promptly diagnose and manage prolapsed intussuscep-tion, clinicians must be able to differentiate it from rectal prolapse. Therefore, a high index of suspicion is key and DRE is mandatory.
To know more click on the document attached.