Complete rectal prolapse in young Egyptian males: Is schistosomiasis really condemned?

Abstract

AIMTo investigate the assumption that schistosomiasis is the main cause of rectal prolapse in young Egyptian males.METHODSTwenty-one male patients between ages of 18 and 50 years with complete rectal prolapse were included in the study out of a total 29 patients with rectal prolapse admitted for surgery at Colorectal Surgery Unit, Ain Shams University hospitals between the period of January 2011 and April 2014. Patients were asked to fill out a specifically designed questionnaire about duration of the prolapse, different bowel symptoms and any past or present history of schistosomiasis. Patients also underwent flexible sigmoidoscopy and four quadrant mid-rectal biopsies documenting any gross or microscopic rectal pathology. Data from questionnaire and pathology results were analyzed and patients were categorized according to their socioeconomic class.RESULTSTwelve patients (57%) never contracted schistosomiasis and were never susceptible to the disease, nine patients (43%) had history of the disease but were properly treated. None of the patients had gross rectal polyps and none of the patients had active schistosomiasis on histopathological examination. Fifteen patients (71%) had early onset prolapse that started in childhood, majority before the age of 5 years. Thirteen patients (62%) were habitual strainers, and four of them (19%) had straining dating since early childhood. Four patients (19%) stated that prolapse followed a period of straining that ranged between 8 mo and 2 years. Nine patients (43%) in the present study came from the low social class, 10 patients (48%) came from the working class and 2 patients (9%) came from the low middle social class.CONCLUSIONSchistosomiasis should not be considered the main cause of rectal prolapse among young Egyptian males. Childhood prolapse that continues through adult life is likely involved. Childhood prolapse probably results from malnutrition, recurrent parasitic infections and diarrhea that induce straining and prolapse, all are common in lower socioeconomic classes.

Outcomes for men undergoing rectal prolapse surgery – a systematic review

“…Men account for 10% of the rectal prolapses seen and treated [5–7]. Rectal prolapse in men is much higher in countries such as Egypt, where it commonly affects younger patients, but the exact mechanism for this is not well known [8–10].…”

“…Factors that may contribute to the development of rectal prolapse include pelvic floor dysfunction, chronic straining, a deep pouch of Douglas and multiparity [1,2]. The condition is estimated to affect 0.5% of the population, with older, multiparous women predominantly affected [3,4].Men account for 10% of the rectal prolapses seen and treated [5][6][7].Rectal prolapse in men is much higher in countries such as Egypt, where it commonly affects younger patients, but the exact mechanism for this is not well known [8][9][10].Surgical management of ERP can be broadly divided into abdominal and perineal approaches [11]. Most of the published literature on rectal prolapse focuses on women, with little guidance on the management of rectal prolapse in men [12].…”

How should we manage complete rectal prolapse in men?

“…Parasitic infection by schistosomiasis is known to cause pelvic floor myopathy and initially this was thought to be the main cause of CRP in young Egyptian men . Subsequently it has been proposed that occult childhood prolapse resulting from malnutrition and recurrent parasitic infections may progress to CRP . Connective tissue disorders, such as Ehlers–Danlos syndrome, may also play a role and be more relevant in men than women.…”