May 25, 2007
Surgical Rounds®, August 2006, Volume 0, Issue 0

Rectal prolapse associated with schistosomiasis

Schistosoma japonicum

I read with interest the April contribution of Baig, et al, which described finding calcified eggs of in the excised specimen of a nulliparous Filipino woman. The authors claim that “childbirth is a primary cause of rectal prolapse,” and “since she had never borne children, we were able to eliminate one of the primary causes of rectal prolapse from consideration.”

To the contrary, several authors have concluded that nulliparity is a predisposing factor for rectal prolapse. In multiple published series on rectal prolapse, nulliparity ranged from 39% to 62%.1-5 Corman notes that “such rates of nulliparity are much higher than would be expected from the general population.”6 Goligher says “these figures indicate that the incidence of complete prolapse in childless women is probably higher than in patients who have borne children.”7 Kupfer and Goligher state “we cannot believe therefore that normal childbirth is a frequent aetiological factor in the production of complete prolapse of the rectum in women.”2

women

Clearly, procidentia is predominantly a disorder of adult women, who constitute at least 80% to 90% of most large series.1,2,4 Therefore, are predisposed to rectal prolapse; however, childbirth is not considered a risk factor.

William C. Cirocco, MD

Kansas City, MO

References

Proc R Soc Med

1. Hughes ESR. Discussion on rectal prolapse of the rectum. . 1949;421:1007.

Br J Surg.

2. Kupfer CA, Goligher JC. One hundred consecutive cases of complete prolapse of the rectum treated by operation. 1970;57(7): 482-487.

Dis Colon Rectum

3. Boutsis C, Ellis H. The Ivalon-sponge-wrap operation for rectal prolapse: an experience with 26 patients. . 1974;17(1):21-37.

Dis Colon Rectum

4. Jurgeleit HC, Corman ML, Coller JA, et al. Symposium: Procidentia of the rectum: Teflon sling repair of rectal prolapse, Lahey Clinic experience. . 1975;18(6):464-467.

Aust

N Z J Surg

5. Ryan P. Observations upon the aetiology and treatment of complete rectal prolapse. . 1980;50(2):109-115.

Colon and Rectal Surgery

6. Corman ML. . 5th ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 2005.

Surgery of the Anus, Rectum, and Colon

7. Goligher JC. . 5th ed. London, England: Balliere Tindall; 1984.

We would like to thank Dr. Cirocco for his comments related to the article “Rectal prolapse associated with schistosomiasis.” We agree with Dr. Cirocco that many studies have documented that rectal prolapse has a higher incidence in women who are

nulliparous; however, the precise etiology of

rectal prolapse has yet to be well defined.1

Dr. Efron responds:

Our primary purpose was to demonstrate the association between schistosomiasis and rectal prolapse and review the other clinical manifestations of schistosomiasis. This infection is thought to be one of the leading causes, if not the leading cause, of rectal prolapse in patients where the disease is endemic.2 This association is not well known in Western countries, including the United States. The patient described in the article had spent a long period of her life in the Philippines and had evidence of schistosomiasis in her resected rectum. It is our contention that the schistosomiasis infection contributed to the formation of the prolapse; however, the exact etiology of her prolapse may never be known.

Jonathan Efron, MD

Scottsdale, AZ

References

1. Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. 2005;140(1):63-73.

2. Abul-Khair MH. Bilharziasis and prolapse of the rectum. Br J Surg. 1976;63(11):891-892.

Intravenous revolution

We in medicine have used various intravenous solutions, but the tried and true are Ringer’s lactate and normal saline. Now, especially in trauma literature, both of these solutions have been found to have some deleterious side effects. I am amazed the solutions haven’t been adjusted to come up with a new blend of the two that would be a great generalized resuscitative fluid.

Ron Graff, MD

Tacoma, WA

Even today in India (as in most third-world countries), hospitals in small cities do not stock intravenous (IV) solutions. Physicians provide a list of IV fluids that will be needed, and the patient’s family members buy the bottles (commonly known as glucose bottles) at a local drugstore and take them to the hospital, often in the middle of the night. I did this a few times as a young kid.

Kirit Antani, MD

Marion, IL