Trans-anal prolapsed gangrenous intussusception in infant

A 4-months-old boy who was previously well, was referred from a primary health service with 4 days history of progress non-bilious vomiting and rectal prolapse. The infant looks dehydrated, lethargic and irritable. In abdominal examination was essentially normal but rectally revealed prolapse gangrenous mass with a gap between the prolapse part and the anus, which allow the examining finger to pass between it. These findings were consistent with diagnosis of prolapse intussusception (A). Urgent laparotomy was undertaken with extended right hemicolectomy after excision of the gangrenous bowel. Ileo-sigmoid colon anastomosis was performed. It is important for clinicians to know “how to differentiate between the rectal prolapse that should be reduced manually in contrast to prolapsed intussusception which requires laparotomy”? This is simply done by rectal examination (A,B). This permits the treating doctor to swiftly decide on proper treatment preference.