Abou-Zeid Ahmed A, ElAbbassy Islam H, Kamal Ahmed M, Somaie Dina A
Ahmed A Abou-Zeid, Islam H ElAbbassy, Ahmed M Kamal, Dina A Somaie, Unit of Colorectal Surgery, Department of General Surgery, El Demerdash Hospital, Ain Shams University, Abbasiya 11566, Cairo, Egypt.
World J Gastrointest Surg. 2016 Dec 27;8(12):779-783. doi: 10.4240/wjgs.v8.i12.779.
To investigate the assumption that schistosomiasis is the main cause of rectal prolapse in young Egyptian males.
Twenty-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.
Twelve 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.
Schistosomiasis 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.
探讨血吸虫病是埃及年轻男性直肠脱垂主要病因这一假设。
在2011年1月至2014年4月期间，艾因夏姆斯大学医院结直肠外科收治的29例因直肠脱垂接受手术的患者中，纳入21例年龄在18至50岁之间的完全性直肠脱垂男性患者。要求患者填写一份专门设计的问卷，内容包括脱垂持续时间、不同的肠道症状以及血吸虫病的任何既往或现病史。患者还接受了乙状结肠镜检查和直肠中段四象限活检，以记录任何肉眼可见或显微镜下的直肠病变。对问卷数据和病理结果进行分析，并根据患者的社会经济阶层进行分类。
12例患者（57%）从未感染过血吸虫病且对该病不易感，9例患者（43%）有该病病史但已得到妥善治疗。组织病理学检查中，所有患者均未发现直肠息肉，也无活动性血吸虫病。15例患者（71%）为儿童期起病的早期脱垂，多数在5岁前发病。13例患者（62%）习惯性用力排便，其中4例（19%）自幼即有此习惯。4例患者（19%）表示脱垂发生在一段持续8个月至2年的用力排便期之后。本研究中9例患者（43%）来自低社会阶层，10例患者（48%）来自工人阶级，2例患者（9%）来自中低社会阶层。
血吸虫病不应被视为埃及年轻男性直肠脱垂的主要病因。可能涉及贯穿成年期的儿童期脱垂。儿童期脱垂可能是由于营养不良、反复寄生虫感染和腹泻导致用力排便和脱垂，这些在社会经济较低阶层中很常见。
