A modified two-stage perineal rectosigmoidectomy for incarcerated rectal prolapse

Fei, R.; Chen, W.; Tao, Xiang; Sheng, Qinsong; Wang, J.; Liu, F.

doi:10.1007/s10151-013-0996-9

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…The rate of anastomotic leak is 2-6% in elective rectosigmoidectomy in contrast to the 25% in incarcerated prolapse. Stapled methods and the two-stage approach have been tried to reduce the leakage rate, but the most common application is protective ileostomy or colostomy (9). Perineal rectosigmoidectomy and protective loop colostomy surgery through one incision is a less invasive surgical option with less risk of contamination as compared to open prolapse surgery.…”

Section: Discussionmentioning

confidence: 99%

Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier’s procedure)

Sipahi

Arslan

Börekci

et al. 2016

UCD

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Perineal procedures have higher recurrence and lower mortality rates than abdominal alternatives for the treatment of rectal prolapse. Presence of incarceration and strangulation also influences treatment choice. Perineal rectosigmoidectomy is one of the treatment options in patients with incarceration and strangulation, with low mortality and acceptable recurrence rates. This operation can be performed especially to avoid general anesthesia in old patients with co-morbidities. We aimed to present perineal rectosigmoidectomy and diverting loop colostomy in a patient with neurological disability due to spinal trauma and incarcerated rectal prolapse. Keywords:Altemeier's procedure, perineal rectosigmoidectomy, rectal prolapse INTRODUCTIONRectal prolapse is a rare disease with an increased frequency after the fifth decade. Rectoanal inhibitory reflex deterioration, high-pressure intermittent rectal motor activity, anorectal sensation disorders, and pudendal neuropathy have been suggested in its pathophysiology, but still its exact etiology is unknown (1). Clinically, it may present as mucosal prolapse (partial or pseudoprolapsus), internal prolapse (rectal intussusception), or full-thickness prolapse (2). Surgical treatment options can be abdominal and/or perineal approach. Despite the higher recurrence rate, due to its low complication rates and better patient tolerance the perineal approach is often preferred in elderly patients with comorbidities, and can be applied in irreducible cases requiring emergency surgery. In this article, a 60-year-old male patient who had had thoracic spine fractures and neurological sequela due to being trapped in a collapsed building twenty years ago, and who underwent perineal rectosigmoidectomy (Altemeier procedure) and protective sigmoid colostomy for incarcerated rectal prolapse is presented. CASE PRESENTATIONA 60-year-old male patient with reduced sensation and muscle strength in both lower limbs and left drop foot sequela due to a traumatic injury twenty years ago presented to the emergency room with an irreducible mass and pain in the anal region that emerged during defecation 6 hours ago. He had experienced fecal incontinence, constipation, and a rectal prolapse that could be manually reduced for the past 6 months. He had hypertension, diabetes mellitus type 2, and was being treated for benign prostatic hypertrophy. The patient was conscious, cooperative, and oriented. On physical examination, his vital signs were normal except for sinus tachycardia (120/min). On anal inspection, he had 20 cm full-thickness prolapse of the rectum and sigmoid colon. The prolapsed segment was edematous and hyperemic. There were areas of ulceration up to 2 cm in diameter. Bowel sounds were normoactive, there were no signs of abdominal tenderness, defense or rebound tenderness. His neurologic examination revealed a left drop foot, and slightly atrophied muscles in both calves and lower limbs, more prominent on the left. Both lower extremity manual muscle strength was determined as 3/5. Although ...

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Section: Discussionmentioning

confidence: 99%

Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier’s procedure)

Sipahi

Arslan

Börekci

et al. 2016

UCD

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“…Aunque algunos reportes de Fei y colaboradores plantean la cirugía en 2 tiempos, un primer tiempo con una incisión circunferencial del segmento prolapsado y un segundo tiempo quirúrgico 2 semanas más tarde en el que se completó la resección y anastomosis con éxito en 3 pacientes. El enfoque en 2 etapas se ha intentado para reducir la tasa de fugas, pero la aplicación más común para disminuir las complicaciones es la ileostomía o la colostomía de protección (15). El curso postoperatorio después de la rectosigmoidectomía perineal suele ser muy favorable.…”

Section: Caso Clínicounclassified

Rectosigmoidectomía perineal (Procedimiento de Altemeier) para el prolapso rectal encarcelado: reporte de un caso

Guzman

Miranda

2018

Rev. Colomb. Gastroenterol.

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Los reportes de prolapso rectal encarcelado son infrecuentes y suponen un reto para el cirujano. Para un prolapso encarcelado no estrangulado, los pacientes deben tratarse con analgésicos y colocarse en la posición de Trendelenburg; y deberían aplicarse medidas conservadoras al prolapso con presión manual simultánea. Si la reducción exitosa no se logra, entonces el paciente generalmente requiere una rectosigmoidectomía con abordaje perineal (procedimiento de Altemeier).Caso clínico: hombre de 57 años, sin una historia previa de síntomas o comorbilidades con predisposición para esta patología. Se presenta en el departamento de urgencias con un prolapso rectal encarcelado posterior a realización de esfuerzo 5 horas antes del ingreso. Se inician medidas conservadoras con colocación en Trendelenburg y aplicación de azúcar granulada tópica. Las medidas fueron infructuosas. El paciente requirió una rectosigmoidectomía con abordaje perineal e ileostomía de protección. El curso postoperatorio no tuvo complicaciones, hubo un excelente resultado después del cierre de la ileostomía y no hubo recurrencia.Discusión: el encarcelamiento conlleva a estrangulamiento a lo largo del tiempo, la cirugía generalmente está indicada si la terapia conservadora fracasa. Aunque tradicionalmente recomendada para los pacientes adultos mayores y pacientes con comorbilidades, los procedimientos perineales son una opción para todos los pacientes y la mejor opción para el prolapso rectal encarcelado.

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“…Since in total prolapse the segment takes on a conical shape with the exteriorization of all rectal layers [1]. It has an incidence of 2.5 / 100,000, and more frequent in elderly women, being related to the multiparity and weakening of the pelvic floor of these patients [2].…”

Section: Introductionmentioning

confidence: 99%

“…It is shown as an exclusively surgical correction pathology, which performance is fundamental due to the social relevance that this disease has, which can generate great damage in the patient's quality of life, restricting her autonomy for daily activities and impairing the social experience due to the manifestations that prolapse generates, such as the constant loss of gas and feces through the half-open anus [2]. For surgical correction, the procedures are divided into abdominal and perineal interventions (focus of this report), always seeking to restore normal Zanatomy and have low morbidity and mortality [3].…”

Section: Introductionmentioning

confidence: 99%

Perineal Rectosigmoidectomy Associated with Low Colorectal Anastomosis for Complete Rectal Prolapse Correction – Altemeier’s Procedure

Gutierrez¹,

Martinez²,

Boratto³

2020

JAMMR

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Introduction: Rectal prolapse constitutes in rectal protrusion through anal orifice. It’s more frequent in elderly women and the correction is exclusively surgical and fundamental, given the condition’s social relevance. We intend to describe a perineal rectosigmoidectomy (Altemeier) for correction of prolapse in multi-morbidity elder patient. Case Report: Female patient, 78 years old, evaluated by proctology ward of CHSBC. She Came in with complaint of anal region bulge for past 2 years. Proctological examination showed 15 cm rectal procidentia Rectal prolapse’s diagnosis came from colonoscopy. A perineal rectosigmoidectomy associated with colorectal anastomosis was done (Altemeier’s Procedure). There was appropriate postoperative evolution, discharge with good wound healing and ambulatorial follow up with good general healing. Discussion: Rectal prolapse is a result of anatomical alterations due to factors such as age and multiparity. Clinical presentation: abdominal discomfort, constipation, feces and gases release. It leads to life quality loss, thus surgical interventions become essential. Corrective surgeries seek to give back fecal continence. Currently, procedures branch out into abdominal and perineal. Altemeier consists in complete rectal removal via perineum. It’s appropriate for high surgical risk elders, since it has the lowest complications rate.

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A modified two-stage perineal rectosigmoidectomy for incarcerated rectal prolapse

Cited by 6 publications

References 3 publications

Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier’s procedure)

Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier’s procedure)

Rectosigmoidectomía perineal (Procedimiento de Altemeier) para el prolapso rectal encarcelado: reporte de un caso

Perineal Rectosigmoidectomy Associated with Low Colorectal Anastomosis for Complete Rectal Prolapse Correction – Altemeier’s Procedure

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