Pescatori and Quondamcarlo reported a grading system for Rectal Internal Mucosal Prolapse (RIMP). This can help to decide on how to manage the patient. The authors are from UCP Villa Claudia in Rome.
With rectal internal mucosal prolapse only the mucosa prolapses. With classic rectal prolapse all or most layers of the rectum prolapse.
Landmarks:
(1) anorectal ring (ARR)
(2) dentate line (DL)
(3) anal verge (AV)
Advancing Edge of Mucosa
Grade
at or above ARR
normal
between ARR and DL
first degree
at DL
second degree
between DL and AV
third degree
Symptoms of mucosal prolapse may include:
(1) obstructed defecation
(2) rectal bleeding
(3) anal discomfort
(4) mucus discharge
(5) fecal soiling
First degree and most second degree RIMP patients can be managed by conservative therapy.
Stapled transanal excision of the prolapse is often needed for severely symptomatic third degree RIMP and some patients with second degree RIMP
To read more or access our algorithms and calculators, please log in or register.
