Surgical rectopexy following persistent rectal prolapse in a premature neonate

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Introduction: Rectal prolapse is a rare but recognized condition in preterm infants, characterized by partial- or full-thickness protrusion of the rectal wall through the anus. While most cases resolve spontaneously with conservative management, prolapse that is persistent or complicated may necessitate surgical intervention. Case Presentation: We present the case of a 25-week gestation female infant who was maintained on non-invasive ventilation and developed persistent rectal prolapse at two months of age during her stay in a tertiary care neonatal intensive care unit (NICU). The infant was initially managed conservatively; management included protective dressings and manual reduction. However, the prolapse progressed in length, with full-thickness protrusion and mucosal changes. The infant was then transferred to a paediatric surgical centre. The prolapse was recurring immediately after manual reduction, with the rectal wall becoming increasingly edematous, leading to significant discomfort. She underwent successful surgical rectopexy. The neonate recovered well post-operatively, tolerated enteral feeds, and was discharged home. At follow-up, she continued to feed and stool normally, with no recurrence of the rectal prolapse. Conclusion: This case highlights the multifactorial etiology of rectal prolapse in preterm infants, including immature pelvic musculature and increased intra-abdominal pressure from chronic respiratory support. While conservative measures remain the mainstay of treatment, surgical management should be considered for refractory cases or if complications arise. The prognosis remains excellent in most cases, with complete resolution of the prolapse as the infant matures. This report adds to the limited literature on the surgical management of neonatal rectal prolapse.

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