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

INTRODUCTION: Conditions associated with increased intraabdominal pressure may lead to rectal prolapse. Like any pathological herniation, rectal prolapse can strangulate if incarcerated. When a patient presents with signs and symptoms of strangulation, emergent surgical intervention is warranted. This report strives to strengthen existing evidence for the use of an Altemeier-type perineal approach as a viable choice for the management of strangulated rectal prolapse in healthy individuals. PRESENTATION OF CASE: A healthy 70-year-old female presents with worsening rectal pain and an irreducible strangulated rectal prolapse. She is brought to the operating suite for an emergent exploration under anesthesia followed by an Altemeier-type procedure without diverting colostomy. The postoperative course is uneventful, and the patient is discharged on postoperative day three. Upon follow up, the patient reports having normal bowel function, and there is no evidence of recurrence. DISCUSSION: Rectal prolapse is traditionally managed through either a perineal or transabdominal approach depending on the patient's clinical disposition. Incarcerated prolapse is a precursor to strangulation, and recent case reports have demonstrated the efficacy of the Altemeier procedure (perineal rectosigmoidectomy) to treat strangulated prolapse. Our initial exploration under anesthesia revealed a small section of ischemic rectal mucosa that was proximal to the rectosigmoid junction. As a result, we decided to remain within perineal parameters and perform the resection in an Altemeier-type fashion based on the boundary of ischemia. CONCLUSION: An Altemeier approach was a reasonable option for emergent surgical management of strangulated rectal prolapse in an otherwise relatively healthy individual. This case has been reported in line with the SCARE criteria (Agha et al. [1]).