title: Risk factors and clinical characteristics of rectal prolapse in young patients.
abstract: 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.
  
  
  CONCLUSIONS
  Medication induced constipation in psychiatric patients and possible pelvic floor weakness in patients with previous pelvic surgery may be contributing factors to rectal prolapse in this group of patients.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500, Euclid avenue, A30, 44195 Cleveland, OH, United States.
authors.forename: C
authors.initials: C
authors.lastname: Sun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500, Euclid avenue, A30, 44195 Cleveland, OH, United States.
authors.forename: T
authors.initials: T
authors.lastname: Hull
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500, Euclid avenue, A30, 44195 Cleveland, OH, United States. Electronic address: ozunerg@ccf.org.
authors.forename: G
authors.initials: G
authors.lastname: Ozuner
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications; D012005:Rectal Prolapse / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Laparoscopic surgery; Rectal prolapse; Risk factors; Surgical management; Young patients