Prolapso rectal encarcelado resuelto por procedimiento de Altemeier Reporte de caso / Incarcerated rectal prolapse resolved by the Altemeier procedure. About a case

RESUMEN El prolapso rectal tiene una incidencia estimada en la población general de 2.5/100000, con predominio del sexo femenino y en pacientes mayores de 50 años. La etiología es multifactorial, el prolapso rectal encarcelado es raro y constituye una urgencia quirúrgica. El procedimiento de Altemeier es una alternativa válida en estos casos por su baja morbilidad. Se describe a continuación un caso clínico de un paciente sometido de urgencias a rectosigmoidectomía de Altemeier, con buena respuesta en el posoperatorio y sin complicaciones post quirúrgicas.

ABSTRACT Rectal prolapse has an estimated incidence in the general population of 2.5 / 100,000, with a predominance in women and in patients over 50 years of age. The etiology is multifactorial, incarcerated rectal prolapse is rare and constitutes a surgical emergency. The Altemeier procedure is a valid alternative in these cases due to its low morbidity. A clinical case of a patient who underwent an Altemeier rectosigmoidectomy is described below, with a good response in the postoperative period and without postoperative complications

Rectosigmoidectomía perineal (procedimiento de Altemeier) para el prolapso rectal encarcelado: reporte de un caso / Case report of perineal rectosigmoidectomy (Altemeier's procedure) for incarcerated rectal prolapse

Resumen Los reportes de prolapso rectal encarcelado son infrecuentes y suponen un reto para el cirujano. Para un prolapso encarcelado no estrangulado, los pacientes deben tratarse con analgésicos y colocarse en la posición de Trendelenburg; y deberían aplicarse medidas conservadoras al prolapso con presión manual simultánea. Si la reducción exitosa no se logra, entonces el paciente generalmente requiere una rectosigmoidectomía con abordaje perineal (procedimiento de Altemeier). Caso clínico: hombre de 57 años, sin una historia previa de síntomas o comorbilidades con predisposición para esta patología. Se presenta en el departamento de urgencias con un prolapso rectal encarcelado posterior a realización de esfuerzo 5 horas antes del ingreso. Se inician medidas conservadoras con colocación en Trendelenburg y aplicación de azúcar granulada tópica. Las medidas fueron infructuosas. El paciente requirió una rectosigmoidectomía con abordaje perineal e ileostomía de protección. El curso postoperatorio no tuvo complicaciones, hubo un excelente resultado después del cierre de la ileostomía y no hubo recurrencia. Discusión: el encarcelamiento conlleva a estrangulamiento a lo largo del tiempo, la cirugía generalmente está indicada si la terapia conservadora fracasa. Aunque tradicionalmente recomendada para los pacientes adultos mayores y pacientes con comorbilidades, los procedimientos perineales son una opción para todos los pacientes y la mejor opción para el prolapso rectal encarcelado.

Abstract 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.

Complete Rectal Prolapse Combined with Rectal Cancer: A Case Report

Colorectal cancer and rectal prolapse occur more frequently in elderly patients. Although the relationship between complete rectal prolapse and colorectal cancer has not yet been clarified, when both diseases develop simultaneously in a patient, it may be due to just coincidence or to a promotion of prolapse due to accelerated constipation caused by cancer. Thus, patients with a sudden onset of rectal prolapse should be screened for colorectal cancer. We report a case of complete rectal prolapse combined with early rectal cancer in a 75 year-old woman who was successfully treated with a perineal rectosigmoidectomy.

Treatment of Rectal Prolapse by a Perineal Rectosigmoidectomy

BACKGROUND: The optimum surgical treatment for rectal prolapse is controversial, and many different operations have been described. The aim of this study is to evaluate the results of a perineal procedure for the treatment of rectal prolapse. METHODS: Between February 1990 and March 1997, 16 consecutive patients underwent perineal rectosigmoidectomy for a complete rectal prolapse. One patient was lost to follow up. The remaining 15 patients were followed up for an average of 58.4 (9~94) months, and clinical and functional outcomes were evaluated. RESULTS: There were 8 males and 7 females, and ages ranged from 18 to 65 years. The mean prolapse duration was 10.7 (0.25~30) years. There were no postoperative deaths. Two patients developed postoperative complications (one wound infection and the other wound hematoma). Five patients had fecal incontinence prior to surgery. Three of the five patients had improved fecal incontinence after the procedure. There were three recurrences (recurrence rate of 20%): one of them underwent a Delorme operation at our institution and others had no treatment. CONCLUSION: A perineal rectosigmoidectomy is a safe and effective operation for the primary treatment of rectal prolapse and has low mortality and morbidity.