Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Aug:109:108504.
doi: 10.1016/j.ijscr.2023.108504. Epub 2023 Jul 13.

A modified perineal approach for the management of strangulated rectal prolapse: A case report

C Biegel  1 , S Brock  2 , J Porter  3 , D Kim  3
Affiliations
Case Reports

A modified perineal approach for the management of strangulated rectal prolapse: A case report

C Biegel et al. Int J Surg Case Rep. 2023 Aug.

Abstract

Introduction: Conditions associated with increased intraabdominal pressure may lead to rectal prolapse. Like any pathological herniation, rectal prolapse can strangulate if incarcerated. When a patient presents with signs and symptoms of strangulation, emergent surgical intervention is warranted. This report strives to strengthen existing evidence for the use of an Altemeier-type perineal approach as a viable choice for the management of strangulated rectal prolapse in healthy individuals.

Presentation of case: A healthy 70-year-old female presents with worsening rectal pain and an irreducible strangulated rectal prolapse. She is brought to the operating suite for an emergent exploration under anesthesia followed by an Altemeier-type procedure without diverting colostomy. The postoperative course is uneventful, and the patient is discharged on postoperative day three. Upon follow up, the patient reports having normal bowel function, and there is no evidence of recurrence.

Discussion: Rectal prolapse is traditionally managed through either a perineal or transabdominal approach depending on the patient's clinical disposition. Incarcerated prolapse is a precursor to strangulation, and recent case reports have demonstrated the efficacy of the Altemeier procedure (perineal rectosigmoidectomy) to treat strangulated prolapse. Our initial exploration under anesthesia revealed a small section of ischemic rectal mucosa that was proximal to the rectosigmoid junction. As a result, we decided to remain within perineal parameters and perform the resection in an Altemeier-type fashion based on the boundary of ischemia.

Conclusion: An Altemeier approach was a reasonable option for emergent surgical management of strangulated rectal prolapse in an otherwise relatively healthy individual. This case has been reported in line with the SCARE criteria (Agha et al. [1]).

Keywords: Altemeier; Case report; Proctectomy; Rectal prolapse; Strangulation.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1
Fig. 1
Segment of rectal prolapse demonstrating strangulation.
See this image and copyright information in PMC

References

    1. Agha R.A., Franchi T., Sohrabi C., Mathew G., Kerwan A., SCARE Group The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int. J. Surg. Dec 2020;84:226–230. doi: 10.1016/j.ijsu.2020.10.034. 33181358 (Epub 2020 Nov 9) - DOI - PubMed
    1. Ben Ameur H., Rejab H., Beyrouti M.I. Altemeier operation for recurred and strangulated rectal prolapse. Indian J. Surg. 2013;75(1):224–226. doi: 10.1007/s12262-012-0656-8. - DOI - PMC - PubMed
    1. Hammond K., Beck D.E., Margolin D.A., Whitlow C.B., Timmcke A.E., Hicks T.C. Rectal prolapse: a 10-year experience. Ochsner J. 2007;7(1):24–32. 21603476 PMC3096348. - PMC - PubMed
    1. Bayar R., Djebbi A., Mzoughi Z., et al. Strangled rectal prolapse in young adults: about a case and review of the literature. Pan. Afr. Med. J. 2016;25:60. doi: 10.11604/pamj.2016.25.60.10721. - DOI - PMC - PubMed
    1. Cernuda R.B., Ángel J.P., Fernández N.T., Sánchez-Farpón J.H., Pérez J.A. Perineal rectosigmoidectomy (Altemeier procedure) as treatment of strangulated rectal prolapse. J. Gastrointest. Surg. 2016;20(12):2102–2103. doi: 10.1007/s11605-016-3190-3. 27384429 (Epub 2016 Jul 6) - DOI - PubMed

Publication types