Procidentia of the rectum after the pull-through operation: an unusual complication and report of two cases

Procidentia or complete prolapse of the rectum following the pull-through operation is unusual, if not altogether rare. It appears to be a late complication of the procedure. A multitude of factors may be implicated in its genesis, and certainly the inadequacy of the pelvic floor is principal among them. Though the exact mechanism is not entirely clear, we favor an intussusceptive process for the reasons and observations cited. It is surmised that its late appearance is primarily due to the formation of adhesions that effectively fix the bowel to the sacrum. The process of aging and ensuing laxity of tissues subsequently detract from this protective factor. Perineal repair was used in both cases but, in the ultimate analysis, the procedure of choice should be individualized, based upon the surgeon's own judgment and experience and particular circumstances attending procidentia.