Incarcerated Recurrent Rectal Prolapse with Ileal Strangulation: Report of a Case

Abstract

We report a rare case of incarcerated rectal prolapse with ileal strangulation occurring after a Gant-Miwa procedure with anal encircling (Thiersch's procedure) for recurrent rectal prolapse. The patient was a 78-year-old woman who presented to our outpatient clinic the day after sudden rectal protrusion had occurred. She had undergone a Gant-Miwa procedure for rectal prolapse 4 years previously, and another Gant-Miwa procedure with anal encircling for recurrent rectal prolapse 18 months earlier. The patient attempted to reduce the prolapse manually, but was unsuccessful. On admission, a 10 x 4-cm semispherical mass was observed extra-anally, with a necrotic surface. We performed an emergency laparotomy, which rerealed a prolapse of the anterior wall of the rectum with part of the ileum protruding into the sac formation. Thus, we resected the incarcerated ileum followed by primary anastomosis and proctectomy (Hartmann's procedure) with good results. This case demonstrates that ileal strangulation can occur as a complication of rectal prolapse recurrence after perineal repair.

Altemeier’s procedure for rectal prolapse: analysis of long‐term outcome in 60 patients

“…Altemeier’s procedure was reserved for emergencies [16,17], elderly patients [18], patients with a high American Society of Anesthesiologists (ASA) score (ASA III and VI), psychiatric patients and young men [5].…”

Complicated rectal prolapse in an infant: strangulated pararectal hernia

“…In irreducible cases, perineal rectosigmoidectomy is preferred because it reduces the risk of contamination of the peritoneal cavity [6][7][8]. In the present case, however, a laparotomy was performed to clarify the cause of associated small bowel obstruction and to aid release of the bowel loops trapped inside the prolapsed rectal walls.…”

“…An extensive search of the literature located only one other similar case, where a 75-year-old lady developed the same type of complicated rectal prolapse [6].…”

Rectosigmoidectomía perineal (Procedimiento de Altemeier) para el prolapso rectal encarcelado: reporte de un caso

“…Una vez en urgencias se debe hacer todo lo posible para reducir manualmente un recto persistente prolapsado no reducible (encarcelado) para evitar complicaciones tales como estrangulamiento, ulceración, sangrado y perforación secundario a la isquemia (6). Se han descrito diversos métodos en la literatura para reducir un prolapso rectal encarcelado: 1.…”