treating the predisposing or underlying condition Bothersome pedunculated lesions can be tied off with silk suture Rectal prolapse , partial or complete herniation of the layers of the rectum through the levator muscle and then the anal orifice, is a phenomenon typically seen in children between and years of age ( Fig 120.24 ) The most common predisposing conditions, severe constipation and severe diarrhea, are characterized by repeated straining on defecation, which stretches pelvic suspensory structures, facilitating herniation Patients with spina bifida may have prolapse as a consequence of deficits in perineal innervation with attendant atrophy of the supporting perineal muscles Rectal prolapse may be the first presenting symptom in children with cystic fibrosis It is also associated with pinworm infection Occasionally, an apparent rectal prolapse represents the lead end of intussusception In these cases, patients have a history of consistent with intussusception including antecedent, intermittent abdominal pain or irritability and may have vomiting, lethargy, and/or rectal bleeding Clinically, a cylindrical mass with a central orifice and a glistening red surface is seen protruding through the anus This can be confused with prolapsed internal hemorrhoids which, unlikely the mass of a rectal prolapse, often have a sulcus that extend perpendicular toward the anus Acutely, the mass can be reduced with steady, gentle pressure Pain control and anxiolysis may be indicated Applying sugar to the exposed mucosa and waiting to 10 minutes can decrease edema and facilitate reduction Emergent surgical consultation should be obtained for ischemic or gangrenous tissue, inability to reduce, or immediate reoccurrence Attention is then directed at identifying and treating the underlying condition to prevent recurrences The need for operative intervention for persistent recurrences is rare and is largely limited to neurologically challenged patients with intractable constipation FIGURE 120.24 Rectal prolapse (Reprinted with permission from Fleisher GR, Ludwig S, Baskin MN Atlas of Pediatric Emergency Medicine Philadelphia, PA: Lippincott Williams & Wilkins; 2004.) Suggested Readings and Key References Ashcraft KW, Thomas MH Acquired anorectal disorders In: Ashcraft KW, Holcomb GW, Murphy JP, eds Pediatric Surgery 6th ed Philadelphia, PA: WB Saunders; 2014 Barksdale EM Jr Surgery In: Zitelli BJ, McIntire S, Nowalk A, eds Atlas of Pediatric Physical Diagnosis 6th ed St Louis, MO: Mosby; 2012:623–674 Bellinger MF Urologic disorders In: Zitelli BJ, McIntire S, Nowalk A, eds Atlas of Pediatric Physical Diagnosis 6th ed St Louis, MO: Mosby; 2012:535– 562 Brukner AL, Frieden IJ Hemangiomas of infancy J Am Acad Dermatol 2003;48:477–493 Canales FL, Newmeyer WL 3rd, Kilgore ES The treatment of felons and paronychias Hand Clin 1989;5:515–523 Chang LC, Haggstrom AN, Drolet BA, et al Growth characteristics of infantile hemangiomas: implications for management Pediatrics 2008;122:360–367 Chayavichitsilp P, Buckwalter JV, Krakowski AC, et al Herpes simplex Pediatr Rev 2009;30(4):119–129 Chi DH, Yellon RF Otolaryngology In: Zitelli BJ, McIntire S, Nowalk A, eds Atlas of Pediatric Physical Diagnosis 7th ed St Louis, MO: Mosby; 2018:868–915 Cohen BA, Davis HW, Gehris RP Dermatology In: Zitelli BJ, McIntire S, Nowalk A, eds Atlas of Pediatric Physical Diagnosis 6th ed St Louis, MO: Mosby; 2012:275–346 Davis HW, Michaels MG Pediatric infectious disease In: Zitelli BJ, McIntire S, Nowalk A, eds Atlas of Pediatric Physical Diagnosis 6th ed St Louis, MO: Mosby; 2012:443–508 Freyer DR, Kennedy R, Bostrom BC, et al Juvenile xanthogranuloma: forms of systemic disease and their clinical implications J Pediatr 1996;129:227–237 Guinto-Ocampo H Incision and drainage of a felon In: Henretig FM, King C, eds Textbook of Pediatric Emergency Procedures Baltimore, MD: Lippincott Williams & Wilkins; 2007:1190–1194 Harter N, Mancini AJ Diagnosis and management of infantile hemangiomas in the neonate Pediatr Clin North Am 2019;66(2):437–459 Henretig FM, King C, eds Textbook of Pediatric Emergency Procedures 2nd ed Baltimore, MD: Lippincott Williams & Wilkins; 2007 Jamshidi R Anorectal complaints: hemorrhoids, fissures, abscesses, fistulae Clin Colon Rectal Surg 2018;31(2):117–120 Jones CD, et al Pilomatrixoma: a comprehensive review of the literature Am J Dermatopathol 2018;40(9):631–641 Leung AK, Robson WL Childhood cervical lymphadenopathy J Pediatr Health Care 2004;18(1):3–7 Loiselle J, Cronan KM Hair tourniquet removal In: Henretig FM, King C, eds Textbook of Pediatric Emergency Procedures Baltimore, MD: Lippincott Williams & Wilkins; 2007:1065–1069 Mat Saad AZ, Purcell EM, McCann JJ Hair-thread tourniquet syndrome in an infant with bony erosion: a case report, literature review, and meta-analysis Ann Plast Surg 2006;57(4):447–452 Michael Al, Ademola SA, Olawoye OA, et al Pediatric keloids: a 6-year retrospective review Pediatr Dermatol 2017;34(6):673–676 Muirhead S Diagnostic approach to goiter in children Paediatr Child Health 2001;6(4):195–199 Mulliken JB, Fishman SJ, Burrows PE Vascular anomalies Curr Probl Surg 2000;37:517–584 Osterman M, Draeger R, Stern P Acute and infections J Hand Surg Am 2014;39(8):1628–1635 Paes JE, Burman KD, Cohen J, et al Acute bacterial suppurative thyroiditis: a clinical review and expert opinion Thyroid 2010;20:247–255 Pagliai KA, Cohen BA Pyogenic granuloma in children Pediatr Dermatol 2004;21:10–13 Paller A, Mancini A Hurwitz Clinical Pediatric Dermatology A Textbook of Skin Disorders of Childhood and Adolescence New York, NY: Elsevier Health Sciences; 2016 Paller AS, Pensler JM, Tomita T Nasal midline masses in infants and children Dermoids, encephaloceles, and gliomas Arch Dermatol 1991;127:362–366 Prendville JS, Krol AL Diseases of the dermis and subcutaneous tissues In: Schachner LA, Hansen RC, eds Pediatric Dermatology 3rd ed New York: Churchill Livingstone; 2003 Rahbar R, Shah P, Mulliken JB, et al The presentation and management of nasal dermoid: a 30 year experience Arch Otolaryngol Head Neck Surg 2003;129:464–471 Raza J, Hindmarsh PC, Brook CG Thyrotoxicosis in children: thirty years’ experience Acta Paediatr 1999;88:937–941 Roberts JR, Hedges JR, eds Clinical Procedures in Emergency Medicine 5th ed Philadelphia, PA: WB Saunders; 2009 Roth DA, Hildesheimer M, Bardenstein S, et al Preauricular skin tags and ear pits are associated with permanent hearing impairment in newborns Pediatrics 2008;122:e884–e890 Sampayo EM, Henretig FM Incision and drainage of a paronychia In: Henretig FM, King C, eds Textbook of Pediatric Emergency Procedures Baltimore, MD: Lippincott Williams & Wilkins; 2007:1085–1089 Shafritz AB, Coppage JM Acute and chronic paronychia of the hand J Am Acad Orthop Surg 2014;22:165–174 Varma R, Williams SD, Wessel HB Neurology In: Zitelli BJ, McIntire S, Nowalk A, eds Atlas of Pediatric Physical Diagnosis 6th ed St Louis, MO: Mosby; 2012:563–596 ... Rectal prolapse (Reprinted with permission from Fleisher GR, Ludwig S, Baskin MN Atlas of Pediatric Emergency Medicine Philadelphia, PA: Lippincott Williams & Wilkins; 2004.) Suggested Readings and... hearing impairment in newborns Pediatrics 2008;122:e884–e890 Sampayo EM, Henretig FM Incision and drainage of a paronychia In: Henretig FM, King C, eds Textbook of Pediatric Emergency Procedures Baltimore,... eds Atlas of Pediatric Physical Diagnosis 7th ed St Louis, MO: Mosby; 2018:868–915 Cohen BA, Davis HW, Gehris RP Dermatology In: Zitelli BJ, McIntire S, Nowalk A, eds Atlas of Pediatric Physical