An enzyme Instead of a Knife: Hyaluronidase in Incarcerated Rectal Prolapse

A BSTRACT Incarcerated rectal prolapse is a surgical emergency that requires prompt intervention to prevent ischemic compromise and necrosis of rectum. We describe the case of a 45-year-old male who presented with a 1-day history of rectal prolapse which was incarcerated on presentation. Initial conservative measures, including topical application of glycerine, failed to facilitate reduction. The patient was subsequently transferred to the operating theater for further management. Circumferential submucosal injection of hyaluronidase was administered into the most edematous part of prolapsed rectum, resulting in rapid resolution of tissue edema and enabling successful manual reduction of the prolapse. Following reduction, a Thiersch wire was placed to mitigate the risk of immediate recurrence. The patient’s postoperative course was uneventful and he was discharged in the stable condition with plan for elective definitive surgical repair after a 3-month interval. This case highlights a novel, minimally invasive approach using hyaluronidase as an adjunct in the management of incarcerated rectal prolapse, with the potential to obviate emergency operative intervention in carefully selected patients.