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Revista colombiana de Gastroenterología
Print version ISSN 0120-9957
Abstract
LOPEZ GUZMAN, Carlos Manuel and SALCEDO MIRADA, Diego Fernando. Case report of perineal rectosigmoidectomy (Altemeier’s procedure) for incarcerated rectal prolapse. Rev Col Gastroenterol [online]. 2018, vol.33, n.4, pp.454-458. ISSN 0120-9957. https://doi.org/10.22516/25007440.170.
Reports of incarcerated rectal prolapse are rare and pose a challenge to the surgeon. For a incarcerated prolapse that is not strangulated, patients should be treated with analgesics and placed in the Trendelenburg position. Conservative measures should be applied to the prolapse with simultaneous manual pressure. If successful reduction is not achieved, then the patient usually requires rectosigmoidectomy with a perineal approach (Altemeier’s procedure).
Case:
The patient was a 57-year-old man with no previous history of symptoms or comorbidities that would predispose him to this pathology. He came to the emergency department with an incarcerated rectal prolapse after attempting to have a bowel movement five hours earlier. Conservative measures of placing the patient in the Trendelenburg placement and topical application of granulated sugar were used. These measures were unsuccessful, so the patient required a rectosigmoidectomy with a perineal approach and protective ileostomy. The patient’s postoperative recovery was without complications and had excellent results after the ileostomy was closed. There has been no recurrence.
Discussion:
Incarceration leads to strangulation over time, so surgery is usually indicated if conservative therapy fails. Although traditionally recommended for elderly patients and patients with comorbidities, perineal procedures are an option for all patients, and this is the best option for incarcerated rectal prolapse.
Keywords : Anorectal disease; rectal prolapsed; incarcerated; perineal rectosigmoidectomy; Altemeier’s procedure.
