Prolapses Agni, Providential Recto and Prolapses Mucosae Recto are the somewhat indefinite terms used to describe the version and prolapse of the rectal walls. If one bears in mind that the anus is simply an aperture, prolapses an is meaningless. Prolapses mucosa recto is applied correctly to the prolapse of the mucosa singly.

Providential Recto includes prolapse of all of the rectal coats, which are the longitudinal and circular muscles and the mucous membrane. It is the complete prolapse of the rectum. In this variety we have three degrees of prolapse.

First Degree. The prolapse begins at the margin of the anus, and its external surface is continuous with the skin surrounding this aperture.

Second Degree. The prolapse begins at a point more or less above the anus and descending through that portion of the gut which remains in position protrudes through the anal orifice.

Third Degree. The prolapse begins high up in the rectum or sigmoid flexible and extends down into the ampul la of the rectum, but does not protrude through the anal orifice. In other words a third degree prolapse of this variety is an imagination of the sigmoid or rectum which does not protrude externally.

archdiocese or Rectal Hernia is another condition of prolapse and may be a complication in the complete prolapse. It is the protrusion into the rectum of some portion of the intestine, usually, the sigmoid flexible It appears in the form of a globular mass, which may descend so far as to protrude externally. Rectal hernia is sometimes the direct cause of a rectal prolapse, with which it may be associated. While authorities differ as to the physical characteristics of a rectal hernia, it seems most probable that it is a sagging of the rectal walls, with a separation of the longitudinal muscle fibers, just at the bottom of the pouch of Douglas. Rectal hernia is sometimes due to a posits of the transverse or descending colon, which has dropped so far into the pelvis as to press against the rectal wall. The X-ray proves that an exaggerated posits of these parts is quite common. The Brandenburg position reduces this form of hernia readily, as a rule.

Rupture of the Hernial Sac may complicate either prolapse or rectal hernia. This may occur in either a hernia, which protrudes through the anal orifice, or when confined within the rectal ampul la Spontaneous rupture may occur or be produced by a traumatize made during attempts at reduction of the prolapse, in which the hernia coexists, More commonly, it occurs spontaneously while lifting heavy weights, straining at stool, and while vomiting. The small intestine or other contents of the hernial sac may protrude without the prolapse being visible as might occur with the third degree of complete prolapse, or be contained within the rectum, in the form of a prolapse; while, if complicating the second degree of complete prolapse, the intestine might be forced outside of the body. Diagnosis is readily made from the appearance of the large or small bowel, when it presents itself. There is immediate collapse, accompanied with very acute pain, shock and protrusion of the intestine into the rectum or outside of the body.

This condition is always serious on account of the liability of infection to the peritoneum. The operation is therefore a serious one and attended with a high mortality. Reduction of the hernia by means of the Brandenburg position is the first step after attempts at sepsis If the hernia is not associated with a prolapse, an abdominal incision in the median line and a repair of the rectal wall made from that side, is the safest procedure. Should a prolapse complicate the condition, a sigmoid can be done to relieve that condition. at the same time.

Fig. 27. Incomplete prolapse of the rectum.