NMS. Casos Clínicos

286

Part II ♦ Specific Disorders

Figure 8-43: Marked dilatation of the cecum and other colonic regions in colonic pseudo-obstruction. When the cecal diameter exceeds 12 cm, the risk for perforation rises substantially. (Reproduced with permission from the Scottish Radiological Society.)

Case 8.36 Rectal Prolapse A 65-year-old presents with anorectal discomfort. The patient reports there is trou- ble initiating defecation. In addition, the patient feels a protrusion from her rectum after moving her bowels. On examination, a patulous anus and a rectal prolapse are evident. Q: What management is appropriate? A: Rectal prolapse, which can occur during defecation, has an unknown cause but may be related to neuromuscular deficiencies and decreased rectal sensation, particularly in older patients (Fig. 8-44). Most patients have a patulous anus and weakened external sphincters. Numerous operations are appropriate for the management of rectal prolapse. If the pro- lapse is entirely internal, treatment with a high-fiber diet to normalize bowel function is warranted, and it may be possible to avoid surgery. However, if the prolapse is external SAMPLE