Perineal Rectosigmoidectomy (Altemeier Procedure) as Treatment of Strangulated Rectal Prolapse

Abstract

Incarceration of a rectal prolapse is an unusual entity that represents a surgical emergency. Even more rarely, it becomes strangulated, requiring emergency surgery. When surgery becomes inevitable, the choice of procedure varies. A 57-year-old man who presented with strangulated rectal prolapse is described. The patient underwent emergency perineal proctosigmoidectomy, the Altemeier operation, combined with diverting loop sigmoid colostomy. The postoperative course was uneventful. After a 6-month follow-up, there was no recurrence, but the patient continued with fecal incontinence. This case underlines the importance of the Altemeier procedure as treatment in the patient with a strangulated prolapsed rectal segment.

Incarcerated complete rectal prolapse managed by Altemeier’s procedure

“…Incarcerated rectal prolapse is rare-occurring in <1% of cases of complete prolapse-and occurs only in patients with long-standing symptoms. 1 To date, <40 cases have been described in the English literature. 2 Rectal incarceration may progress to strangulation, which is life-threatening, but may be the first presentation.…”

“…A perineal approach avoids the complications of laparotomy and is the preferred alternative especially where the prolapse is incarcerated, even at the gangrenous stage, and where reduction by external manual compression is not feasible. 1,4 Proximal diversion is advised in 25% of cases. 3,5…”

“…However, ASV may cause early anaphylactic reactions in 11% and pyrogenic reactions in 25% of victims. 1 A poor outcome of ASV treatment is usually associated with its delayed initiation and associated complications of high dosage, related to allergic reactions. 2…”

Case series: Incarcerated massive rectal prolapse successfully treated with Altemeier’s procedure

“…Another case was reported by Cernuda and colleagues in which a patient was treated with perineal rectosigmoidectomy and a diverting colostomy was utilized. Subsequently, after six months follow-up there was no evidence of recurrent prolapse [ 9 ].…”

Painful Perineal Mass: What Is the Diagnosis?

“…1 The most common treatment of strangulated rectal prolapse is the perineal colorectal resection, as described by Altemeir, with or without a diverting stoma. 2,3 Hartmann's procedure has also been reported in 1 case. 1 In our case, we decided to avoid a transperineal sigmoid resection and the subsequent intraperitoneal coloanal anastomosis (as it is done in Altemeir procedure) for several reasons.…”