Zusammenfassung
Als Rektumprolaps wird die teleskopartige Einstülpung des Rektums in distal gelegene Rektumabschnitte bezeichnet. Es findet sich eine deutliche Häufung der Erkrankung beim weiblichen Geschlecht und eine zweigipflige Altersverteilung – bei Kindern und bei Patienten über 50 Jahren. Die genaue Pathogenese und Ätiologie des Rektumprolapses sind unklar. Als ätiologische Faktoren werden Bindegewebsstörungen, Myopathien und Neuropathien diskutiert. Hinsichtlich der Pathogenese werden v. a. 2 unterschiedliche Konzepte zur Entstehung des Rektumprolapses in Betracht gezogen: die Gleithernientheorie und die Interpretation der Entstehung eines Rektumvollwandprolapses als sequenzielle, fortschreitende Entwicklung eines zunächst inneren Rektumprolapses. Diese pathophysiologischen Erklärungen der Prolapsentstehung basieren aber v. a. auf klinischen Beobachtungen und nicht auf kausal nachzuweisenden Zusammenhängen. Insgesamt dürfte die Entstehung des Rektumprolapses multifaktoriell sein und auf einer Kombination aus funktionellen Störungen und anatomischen Veränderungen basieren. Die relative Relevanz der einzelnen pathophysiologischen und pathomorphologischen Komponenten beim betroffenen Individuum bleibt oft nicht schlüssig erklärbar; vielmehr erscheint es wahrscheinlich, dass jeder Patient ein individuelles Pathomechanismusprofil aus den unterschiedlichen ätiologischen Faktoren aufweist. Grundlage der Diagnostik eines Rektumprolapses sind eine detaillierte Anamneseerhebung und eine gezielte klinische Untersuchung. Ein externer Rektumprolaps kann meist bereits klinisch diagnostiziert werden. Die Defäkographie als weiterführende diagnostische Maßnahme hilft bei der Detektion häufig bestehender morphologischen Begleitpathologien.
Abstract
Rectal prolapse refers to the invagination of the rectum into distal rectal segments. There is a marked accumulation of the condition in the female gender and a bimodal age distribution in children and in patients over 50 years. The exact pathogenesis and etiology of rectal prolapse are unclear. Tissue disorders, myopathies and neuropathies are discussed as etiological factors. With respect to the pathogenesis, there are two main concepts for the development of the rectal prolapse: the hernia theory and the interpretation of a rectal full-thickness prolapse as a sequential, progressive development of an initially internal rectal prolapse; however, these pathophysiological theories are mainly based on clinical observations. Overall, the development of rectal prolapse is likely to be multifactorial and based on a combination of functional disorders and anatomical changes. The relative relevance of the individual pathophysiological and pathomorphological components in the affected individual often remains unclear, but it seems likely that each patient has an individual pathomechanism profile due to various etiological factors. The basis of the diagnosis of a rectal prolapse is a detailed medical history and a targeted clinical examination. An external rectal prolapse can usually be diagnosed clinically. Defecography as a further diagnostic measure has a high priority because of the frequent coexistence of morphological pathological disorders.
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K.E. Matzel gibt an, ärztlicher Berater für Medtronic zu sein. C. Handtrack und M. Brunner geben an, dass kein Interessenkonflikt besteht.
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Handtrack, C., Brunner, M. & Matzel, K.E. Externer Rektumprolaps. coloproctology 40, 166–174 (2018). https://doi.org/10.1007/s00053-018-0242-z
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DOI: https://doi.org/10.1007/s00053-018-0242-z