Massive chronic irreducible rectal prolapse successfully treated with Altemeier's procedure

Abstract

The guideline for the treatment of rectal prolapse recommends that surgeons select appropriate surgical procedures individually based on each patient's overall status. However, in cases of irreducible or incarcerated rectal prolapse, surgical options are quite limited. Here we present a case of an elderly woman with massive chronic irreducible rectal prolapse. An 87-year-old woman presented to our hospital with a complaint of massive rectal prolapse. The prolapsed rectum was over 20 cm long, and completely irreducible. She underwent perineal rectosigmoidectomy with levatorplasty known as Altemeier's procedure. More than 30 cm of rectosigmoid colon was resected. After the operation, rectal prolapse was resolved completely. Her postoperative course was uneventful, and her quality of life and bowel movements improved. She has since been healthy without recurrence for over 2 years. Altemeier's procedure is applicable even in cases of irreducible rectal prolapse and features acceptable safety and a satisfactory outcome.

Figure 1:

Preoperative findings. A massive rectal prolapse is observed. The prolapsed rectum shows edematous changes.

Figure 2:

Pelvic computed tomography image. Full-thickness prolapse of redundant rectosigmoid colon from the anus is observed. (a) Axial section and (b) sagittal section.

Figure 3:

Resected specimen. The resected rectosigmoid colon was >30 cm long. (a) Before reduction and (b) after reduction.

Figure 4:

Postoperative findings. The rectal prolapse is completely resolved.