COMPLETE PROLAPSE, OR PROCIDEN TIA RECTI.—When partial prolapse has repeatedly occurred, it is apt to result in the more serious form, in which all of the tunics of the bowel are involved. In some instances an extensive prolapse takes place suddenly as a result of vio lent straining. In both conditions the tumor forms a protrusion of variable size, more or less pyramidal in form, which projects from the anus. At its distal end is the opening into the bowel, and this opening is generally narrow and slit like.
When the prolapse involves more than two and a half inches of the rectum, it is well to remember that the peritoneum may be involved, and that within this serous sac and included in the prolapsed portion of the rectum a coil of the small intestine may be found. In this variety there is no invagination. This form of prolapse may assume extensive propor tions, the greater portion of the colon being extruded.
The symptoms of complete prolapse are similar to those in the first variety, but are usually more aggravated. Mucus
is present, and even pus may be found when this condition is associated with ulceration. Pain, when present, is not usually severe, as the mucous membrane here seems to be purposely endowed with a lowered sensibility. This fact accounts for the considerable amount of trauma which the rectal mucous membrane stands without producing much suffer ing, as is exhibited in advanced and ex tensive malignant disease of the rectum. When the peritoneal coat of the intestine is involved, the sac of the hernia,so called, is to be looked for upon the anterior sur face of the protrusion, as the peritoneal pouch does not descend nearly so far upon the posterior as upon the anterior wall of the rectum. Where the protru sion measures more than three inches, Ball states that the mass is generally curved, the concavity looking toward the coccyx, and in extreme cases it may be arranged in a more or less spiral manner.