Güncel Proktoloji: Anorektal Hastalıklar ve Modern Yaklaşımlar

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REKTAL PROLAPSUS

Dr. İlknur TURAN

Özel Çiftlikköy Aktif Hastanesi, Genel Cerrahi Kliniği, Yalova, Türkiye

ÖZET

Rektal prolapsus, rektumun anüsten dışarı çıktığı bir durumdur. Rektal duvarın anal kanaldan geçip geçmediğine bağlı olarak, total veya internal olarak sınıflandırılabilir. En yaygın olarak yaşlı kadınlarda görülür ve yaklaşık 1000 kişiden 1’ini etkiler. Bu duruma pelvik taban zayıflığı, nöropati veya rektum ve sigmoid kolonun yapısal anormallikleri gibi faktörler neden olabilir. Belirtiler arasında prolapsusun şiddetine bağlı olarak değişebilen kabızlık, eksik dışkılama ve inkontinans yer alır.

Teşhis genellikle klinik muayene ve prolapsusun boyutunu ve diğer pelvik organların etkilenip etkilenmediğini değerlendirmek için defekografi veya MRI gibi görüntüleme tekniklerini içerir. Tedavi öncelikle cerrahidir ve normal anatomiyi düzeltmeyi, bağırsak fonksiyonunu iyileştirmeyi ve inkontinansı tedavi etmeyi amaçlar. Lif takviyesi veya biofeedback gibi cerrahi olmayan yaklaşımlar geçici rahatlama sağlayabilir ancak tedavi edici değildir. Cerrahi seçenekler arasında rektopeksi ve sigmoid rezeksiyon gibi abdominal prosedürler ve Altemeier ve Delormé prosedürleri gibi perineal teknikler yer alır. Ameliyat seçimi genellikle yaş, komorbiditeler ve inkontinans varlığı gibi faktörlere bağlı olarak hastaya özeldir.

Anahtar Kelimeler: Rektal prolapsus; Pelvik taban bozuklukları; Anal sfinkter displazisi; Fekal inkontinans; İntussepsiyon; Rektum

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