A 54-Year-Old Man with a Large Rectal Prolapse Treated with Perineal Proctosigmoidectomy with Levatorplasty (Altemeier Procedure): Presentation of Case and Review of Literature

Abstract

Objective:Rare disease Background:The surgical procedure of perineal proctosigmoidectomy with levatorplasty is known as the Altemeier procedure. This report presents the case of a 54-year-old man with a large rectal prolapse treated with perineal proctosigmoidectomy with levatorplasty (Altemeier procedure). Case Report:A 54-year-old male had a large bulging in the rectum since 5 months ago. At first, the bulging was small, but its size had increased to approximately 10 cm at presentation. The patient also stated that the bulging used to reduce spontaneously after defecating or manually by applying sufficient pressure, but lately it had been irreducible. Another concern was chronic constipation over the last few years, which was treated with over-thecounter laxatives and stool softeners. Physical examination of the perianal region revealed a full-thickness, irreducible, prolapsed bowel segment, approximately 10 cm long, with multiple mucosal ulcerations. Grade V rectal prolapse was diagnosed. Follow-up at 7, 14, and 30 days after surgery showed complete resolution of symptoms and no recurrence. Conclusions:Individually tailored and prompt surgical treatment for all patients with rectal prolapse is vital. The Altemeier procedure, which has good efficacy with low morbidity, complications, and recurrence, should be considered in elderly patients with an irreducible, large rectal prolapse.