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Question: GI

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A 10 month old infant with history of constipation comes in with a 1cm dark red (but not dusky) painless mass extruding from the anus. The patient is afebrile, well appearing and playful, and the remainder of the exam is unremarkable.

Rectal_Prolapse_Toddler_1 Wikimedia Commons, user BellaVuk

What is your best course of action?

pemsou5_wp • April 17, 2018

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  1. Kelly April 18, 2018 - 12:38 pm Reply

    B) Rectal prolapse, as pictured, is most common in the first year of life, and is usually benign and self-limited in children < 4 years. Increased risk occurs with constipation or other causes of increased intraabdominal pressure, diarrheal disease, cystic fibrosis, malnutrition, and pelvic floor weakness. Manual reduction ASAP is indicated, and placing sugar on the prolapsed mucosa may help reduce edema. Both hemorrhoid (unusual in this age group) and pyogenic granuloma would be more localized. Miralax will be indicated, but the prolapse should be reduced first.

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