Management of irreducible giant rectal prolapse: A case report and literature 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

“…Rectal prolapse is an external protrusion of the rectal mucosa through the external anal sphincter [ 1 ]. It is classified in to 3 clinical subtypes: mucosal invagination, incomplete (partial; internal), and complete (full-thickness; external) [ 2 ]. Fecal incontinence, obstructed defecation, incomplete rectal evacuation, rectal pressure, and pain are some of the symptoms that can result from rectal prolapse [ 4 ].…”

“…Rectal prolapse is an external protrusion of the rectal mucosa through the external anal sphincter [ 1 ]. Rectal prolapse affects all ages but is more common in children, women, and patients >50 years of age [ 2 ]. Some factors have been shown to be associated with the development of rectal prolapse, but the exact cause of rectal prolapse is unknown.…”

“…Most rectal prolapses can resolve spontaneously or by manual reduction. In some cases, the prolapsed segment cannot be reduced and becomes incarcerated, which can lead to complications including severe pain, bleeding, strangulation, and even perforation [ 2 ].…”

A case report of largest rectal prolapse in the literature successfully treated with Altemeier's procedure

“…Since the abdominal approach is difficult to adopt, we had no choice but to select the perineal approach in this case. Perineal proctosigmoidectomy, also known as Altemeier's procedure is one of the popular techniques in the emergency setting for almost all patients with acceptable outcomes [ 4 , 12 , 13 ]. Also, a temporary diversional loop such as ileostomy or colostomy can be considered for patients to ensure the excellence of anastomosis healing due to the surgeon's judgments [ 14 ].…”

“…Complete rectal prolapse, also known as rectal procidentia or the third-degree prolapse is the full thickness projection, is an increasing clinical concern that is usually found in old female patients [ 2 , 3 ]. Increased intra-abdominal pressure in conditions such as chronic constipation, or pelvic floor/anal sphincter musculature weakness is the main underlying condition [ 2 , 4 ]. Once the projection occurs, nonoperative or operative interventions are mandatory to reduce it as soon as possible with the least complications [ 5 ].…”