INTERNAL RECTAL PROLAPSE - THERAPEUTIC RE SULTS AND CURRENT POSITION

Internal procidentia or internal rectal prolapse (intussusception) sti ll represents a therapeutic problem: it may be a secondary phenomenon in a primary functional disorder, or it may itself represent the cause of outlet obstruction amenable to cure by prolapse operation. Over a 10-year period 49 patients underwent surgery due to severe symptoms an d resistance to conservative treatment. Symptoms and findings were obs tructive constipation (65%), tenesmus and pain (55%), mucus discharge and bleeding (26%), and incontinence (24%). 12 (24%) of the patients h ad a solitary rectal ulcer syndrome. The operative procedure consisted in rectal mobilization, elevation, rectopexy, with rectosigmoid resec tion in 45 patients. 1-9 (mean 3) years after the operation 10 patient s (21%) had a poor functional outcome, though the intussusception was cured in 48 patients. A favorable result was most frequently noticed i n patients with incontinence, incipient external prolapse, and also in those with a solitary rectal ulcer syndrome. 35% of the patients with obstruction, severe pain and normal continence did not benefit from t he operative procedure.