Strangulated recurrent rectal prolapse after a Delorme intervention, a case report

Abstract

Key Clinical Message A surgeon must be aware of indications of rectal prolapse surgery with proper preoperative evaluation and have the ability to recognize complications. Sigmoid redundancy might lead to early recurrence, which itself could complicate into strangulation. Complications per say might require more drastic measures, as Hartmann's procedure in this case.

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

“…When compared to a transabdominal approach, rectal prolapse was managed successfully with the Altemeier procedure despite higher rates of recurrence [ 2 , 6 , [8] , [9] , [10] , [11] ]. Because perineal procedures are generally chosen in cases of strangulation, comparisons have been made between Altemeier and Delorme on the topic of recurrence after strangulation as well [ 12 , 13 ]. Based on experience, some surgeons recommend avoidance of the Delorme procedure, especially in instances of necrosis and edema [ 3 , 4 , 7 , 9 ].…”

“…Because perineal procedures are generally chosen in cases of strangulation, comparisons have been made between Altemeier and Delorme on the topic of recurrence after strangulation as well [ 12 , 13 ]. Based on experience, some surgeons recommend avoidance of the Delorme procedure, especially in instances of necrosis and edema [ 3 , 4 , 7 , 9 ]. The Altemeier is usually favored in cases of strangulation because observed recurrence rates were lower than for Delorme [ 12 ].…”

“…The Altemeier is usually favored in cases of strangulation because observed recurrence rates were lower than for Delorme [ 12 ]. Both recurrence and complication rates seem to be normalizing now that transabdominal approaches are minimally invasive, however, further research is needed to determine this trend [ 12 , 13 ]. Our resection was limited to the rectum and as such, there is concern for recurrence.…”

Anorectal emergencies: WSES-AAST guidelines

“…For these reasons, the perineal approach could be a feasible option for elderly or medically unfit patients when appropriate skills and expertise are available. -Abdominal approaches have the benefit of entering the abdominal cavity, thus are the best choice in case of patients with associated peritonitis [238,242]. Hartmann's procedure can be an option in case of patients with rectal incontinence and in patients with signs of sepsis; moreover, Hartmann's procedure can be safely performed by emergency general surgeons.…”