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Review
. 2023 Jun 1:24:e939508.
doi: 10.12659/AJCR.939508.

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

Andriana Purnama  1 , Reno Rudiman  1 , Tovan Perinandika  2
Affiliations
Review

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

Andriana Purnama et al. Am J Case Rep. .

Abstract

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-the-counter 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.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
An irreducible, large rectal prolapse with mucosal ulceration, with an approximate length of 10 cm.
Figure 2.
Figure 2.
Marking of the resection line 1 to 2 cm proximal to the dentate line was done with an ultrasonic knife.
Figure 3.
Figure 3.
A circumferential incision on the pre-marked line, including all layers of the rectal wall.
Figure 4.
Figure 4.
Resected prolapsed rectum and part of the sigmoid colon.
Figure 5.
Figure 5.
The postoperative result.
See this image and copyright information in PMC

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