Laparoscopic-Assisted Altemeier’s Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report
Unusual clinical course, Unusual setting of medical care, Educational Purpose (only if useful for a systematic review or synthesis)
Wael M. Al-Ameen, Antonio Privitera, Amal Al-Ayed, Khalid Sabr
Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
Am J Case Rep 2016; 17:827-829
Rectal prolapse is an uncommon disease that usually requires surgical intervention. Several techniques have been described with either an abdominal or perineal approach, the latter having a higher recurrence rate. In case of irreducible and strangulated full-thickness prolapse, a perineal approach is necessary, and efforts should be made to reduce recurrence rates.
CASE REPORT: A 39-year-old mentally retarded woman presented with a painful, recurrent, strangulated sigmoid prolapse following a perineal recto-sigmoidectomy (Altemeier’s procedure) for strangulated rectal prolapse 2 months previously. Examination revealed a 10-cm strangulated, prolapsed sigmoid. A laparoscopic-assisted perineal sigmoid resection with colo-anal anastomosis was carried out. The patient made an uneventful recovery and was discharged on the 6th postoperative day.
CONCLUSIONS: This is the second report in the literature highlighting the role of laparoscopy in Altemeier’s procedure for strangulated prolapse. Laparoscopy aids assessment of sigmoid length, allows colonic mobilization, and assures that all redundant bowel is excised. This approach can reduce recurrence rate and need of further surgical interventions.
Keywords: intellectual disability, Laparoscopy, Postoperative Complications, Rectal Prolapse, Reoperation