Rectal prolapse in the mentally retarded

Summary

A series of 25 cases of complete rectal prolapse, treated at a hospital for the mentally retarded over a 7-year period, has been presented. Since the patient population of this hospital is but 3,000, it seems reasonable to assume that the incidence of complete rectal prolapse among these patients is high. The causative factors of complete rectal prolapse—both congenital and developmental — have been discussed. Among these patients the developmental factors seem to play a major role. The tremendous variation in methods of operative treatment for this condition has been discussed. Perineal rectosigmoid amputation has yielded the poorest results and the most serious complications. Far superior results have been obtained when the defect in the musculofascial pelvic diaphragm could be closed adequately and the rectum fixed in its normal posterior position in the sacral curve. Of 11 operations performed by way of the abdominal approach, using either the Graham or Pemberton procedures, there was but a single recurrence. The only postoperative death occurred after a third operation (Graham procedure) required by recurrences after perineal amputation and a Pemberton type of fixation procedure.