Rectal Mass

This week in clinical we had an elderly woman who frequently has a mass extrude from her rectum. The rectal mucosa actually turns inside out and looks as if a plum is coming out of her anus (It's the size, shape, and color of an plum). She had a hysterectomy many years ago and also a bladder tack. The patient's primary nurse gently reinserted the mass into the rectum. She stated this was prolapsed intestines and a common occurrence with this patient. (The doctor is fully aware.) I have seen a totally prolapsed uterus before, coming out through the vagina, but NEVER anything prolapsing through the rectum. It was quite an experience for the student, I might add, and she handled it very well. What is this condition called? (I know it's called enterocele when it occurs in the vagina.) Thanks for any information on this condition you can offer.

[Nurse Ratched, RN]

Rectocele?

http://www.emedicine.com/med/topic3325.htm

Don't you just love something interesting to show your students? :)

[nurseygrrl, LPN]

It's called a prolapsed rectum. I've had pts. with it before.

[Tweety, BSN, RN]

Prolapsed rectum is what it sounds like. I've seen them. Usually needs surgical correction.

The last one I saw was on an elderly patient with c. diff. copious amounts of diarrhea. They didn't want to operate because she had c-diff and was in poor health. So whenever it popped out we just put it back in.

Many nurses were not comfortable with this. They didn't feel it was within the nurses scope of practice to put back a prolapsed rectum. Since I had seen it done before by nurses I didn't give it a second thought. Now I'm not so sure.

[jemb]

Rectocele. And you decscribed it perfectly, Vicky.

[memphispanda, RN]

It is not rectocele--that is when there is a herniation of the rectum into the vagina. I don't know if there is a more "medical" term for it than rectal prolapse.

[VivaLasViejas, ASN, RN]

Nope, it's a rectal prolapse. In LTC I once had a resident with this condition, and we had to push it back up inside every so often. Of course, we did this as a clean procedure, and there were never any ill effects as far as we knew. But then, there's all kinds of things you do in LTC that you'd never do in any other setting, like putting G-tubes back in using a Foley catheter and treating decubs according to whoever is charge nurse on a given day. I had another resident who was about 300# and had to have a return flow enema every single morning at 0900 on the dot. Trouble was, you had to advance the tubing up about 18 inches.......and I was NEVER comfortable doing that, I was terrified of causing a bowel perf, but even the MD told us all not to worry about it. I'm glad I didn't stay at that facility long!

[florry]

If the muscl tonus is so low, and the pt, fex. is obstipated, you can risk that the tarm is faing out, inside out . Put it back with a glove on, and encourage the pt to lie down and rest for a littlle time. YOU MUST DO YOUR OBSERVATION, BECAUSE IT CAN BE STRANGULATION AND TTHE COLOR CHANGE TO !:)

[live4today, RN]

Hi Vicky :)

I've seen a patient with rectal prolapse before, and it was exactly as you described. I've only seen it once though, and it was on a geriatric patient.

[sharann, BSN, RN]

Yep, Rectal prolapse is what it was. I saw it once in a pt from ER to OR. He had a prolapse the size of a small basketball (I kid you not). To fix it (yes I just had to watch) the surgeon had the anesthesiologist pput the guy waaaay under, to relax the muscles down there, then the doc took a towel and used his entire fist up to his almost elbow (OH YES HE DID), and then removed the towel carefully. The towel was for "traction" as he put it. A minute later the whole thing POPPED back out. So he had to wait for the general to wear off slightly as he repeated this procedure.

This patient was apparently a "inserter" Enough said huh?:imbar

[Rapheal]

Originally posted by florry

If the muscl tonus is so low, and the pt, fex. is obstipated, you can risk that the tarm is faing out, inside out . Put it back with a glove on, and encourage the pt to lie down and rest for a littlle time. YOU MUST DO YOUR OBSERVATION, BECAUSE IT CAN BE STRANGULATION AND TTHE COLOR CHANGE TO !:)

I have cared for 2 patients with this and one patient called it a prolapsed rectum. I asked the doctor what to do on the first person I saw it on and she told me to do nothing but keep it clean. I had no idea it should have been put back in. Thanks for the new knowledge florry. You learn something new every day. I will also research this a little further.

[florry]

Hello again!

Thank you for sharing knowledge. I ddnt say (probably because of my "norwenglish", that strangulantion is creating ishemia and in worst case necrosis, but I assumed you understood that!

I have seen one old lady with "a blue strangulated rectum falling out", she was dement to, and very difficult to cooperate with, but she had to operate immedietly and she got a colostomia on her abdomen.

Thank you everyone to being so patient with my english!

:)