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Risk Factors And Clinical Characteristics Of Rectal Prolapse In Young Patients

Sun C, Hull T and Ozuner G*

Background: Rectal prolapse is a relatively common condition in children and elderly patients but uncommon in young adults less than 30 years old. The aim of this study is to identify risk factors and characteristics of rectal prolapse in this group of young patients and determine surgical outcome.

Methods: Adult patients younger than 30 years old with rectal prolapse treated surgically between September 1994 and September 2012 were identified from an IRB approved database. Demographics, risk factors, associated conditions, clinical characteristics, surgical management and follow-up were recorded.

Results: Forty-four (females 32) patients were identified with a mean age of 23 years old. Eighteen (41%) had chronic psychiatric diseases requiring treatment and these patients experienced significantly more constipation than non-psychiatric patients (83% vs. 50%; P=0.024). Thirteen (30%) patients had previous pelvic surgery. The most common symptom at presentation was a prolapsed rectum in 40 (91%) and hematochezia in 24 (55%). Twenty-four (55%) underwent a laparoscopic rectopexy, 14 (32%) open abdominal repair, and 6 (14%) had perineal surgery. The most common procedure was resection rectopexy in 21 (48%; 7 open; 14 laparoscopic). At a median follow-up of 11 (range 1-165) months, 6 patients (14%) developed a recurrence; 3 (13%) after laparoscopic, 2(14%) after open abdominal and 1(17%) after perineal surgery.

Conclusions: Medically induced constipation in psychiatric patients and possible pelvic floor weakness in patients with previous pelvic surgery may be contributing factors. Abdominal repair is the most common procedure with recurrence rates that are comparable to published literature for older individuals.