Complete Rectal Prolapse Associated with Redundant Sigmoid Colon in Young Psychiatric Patients: Anterior Resection of the Rectosigmoid is a Safe and Effective Choice of Operation

Author(s): Anestis Charalampopoulos, Anastasia Pikouli, Panagiotis Latsonas, George Kirkilesis, George Bagias, Dimitrios Papaconstantinou, Savvas Papagrigoriadis

Introduction: Complete Rectal Prolapse is a chronic condition affecting older patients, mainly females and more rarely children. The disease is rare in middle aged patients and surgery is the only treatment option.

Goal: To describe a selected and rare group of patients with complete rectal prolapse with redundant colon, psychiatric diseases and severe constipation.

Material and methods: Twelve patients were studied with regards to demographics, past medical history, physical examination findings, surgical treatment and short-term outcomes.

Results: There were 12 patients (7 females, 5 males, and age range 25-39yrs, mean age 32yrs) all of whom had a history of psychiatric disease, constipation and redundant sigmoid colon on endoscopy. The complete rectal prolapse was present less than 6 months. The main characteristics were severe constipation, absence of incontinence and absence of other pelvic floor disorders. All females were nulliparous without a current or past diagnosis of any other pelvic floor prolapse. The redundant sigmoid colon was diagnosed by endoscopy. The surgical treatment applied in all cases was anterior resection of the rectum and the redundant sigmoid colon with an anastomosis in the mid rectum. No rectopexy was performed. There was no formation of any stoma. There were no anastomotic leaks and no major complications. The functional result was good in all cases with subjective improvement of the constipation. Follow up was 6 months (4-14).There were no recurrences of rectal prolapse.

Conclusions: Complete rectal prolapse in young patients with psychiatric disease and redundant colon is a special group that may be unsuitable for rectopexy. The existence of the redundant sigmoid colon, probably participate significantly in chronic preoperative constipation and is a cause of postoperative constipation. We have showed that in patients with similar characteristics one-stage anterior resection of the rectosigmoid is a safe and effective operation.