title: Morphological alterations of the enteric nervous system in young male patients with rectal prolapse.
abstract: OBJECTIVE
  The pathogenesis of rectal prolapse (RP) defined by a circumferential, full-thickness invagination of the rectal wall into the anal canal is controversial. RP is normally encountered in elderly women and attributed to several etiological factors (e.g., advanced age, pudendal nerve injury, laxity of supporting ligaments). RP affecting young male patients is unlikely to be explained by these factors and may be due to a rectal motility disorder. Therefore, the enteric nervous system (ENS) as key regulator of intestinal motility was evaluated by a systematic morphometric analysis.
  
  
  METHODS
  Full-thickness rectosigmoid specimens obtained from young male patients with symptomatic RP (n = 5) and male controls (n = 15) were processed for conventional histology and immunohistochemistry using anti-HuC/D as pan-neuronal marker. Enteric ganglia, nerve and glial cells were quantified separately in the myenteric (MP) and submucosal plexus (SMP).
  
  
  RESULTS
  Compared to controls, patients with RP showed significantly (p < 0.05) increased mean ganglionic area both in MP and SMP, increased mean neuronal content of submucosal ganglia, and nearly threefold higher frequency of submucosal ganglia containing ≥7 neurons.
  
  
  CONCLUSIONS
  The morphometric analysis reveals distinct quantitative alterations of the ENS in young male patients with RP mainly characterized by submucosal hyperganglionosis similar to histopathological features described in intestinal neuronal dysplasia. The data give evidence that RP in this unusual subgroup is associated with morphological changes of enteric ganglia which may contribute to the development of RP and complement established etiological concepts.
authors.affiliation: Department of Anatomy, Christian Albrechts University in Kiel, Otto-Hahn-Platz 8, 24118, Kiel, Germany.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Zorenkov
authors.forename: Susanne
authors.initials: S
authors.lastname: Otto
authors.forename: Martina
authors.initials: M
authors.lastname: Böttner
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hedderich
authors.forename: Oliver
authors.initials: O
authors.lastname: Vollrath
authors.forename: Jörg-Peter
authors.initials: JP
authors.lastname: Ritz
authors.forename: Heinz
authors.initials: H
authors.lastname: Buhr
authors.forename: Thilo
authors.initials: T
authors.lastname: Wedel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D017615:Enteric Nervous System / Q000473:pathology*; D005260:Female; D005724:Ganglia / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009197:Myenteric Plexus / Q000473:pathology; D009457:Neuroglia / Q000473:pathology; D009474:Neurons / Q000473:pathology; D012005:Rectal Prolapse / Q000150:complications / Q000473:pathology*; D013368:Submucous Plexus / Q000473:pathology