Laparoscopic-Assisted Altemeier’s Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report

Patient: Female, 39 Final Diagnosis: Recurrent strangulated rectal prolapse Symptoms: Chronic constipation • painful rectal mass • irreducible rectal prolapse Medication: — Clinical Procedure: Operation Specialty: Surgery OBJECTIVE: Management of emergency care BACKGROUND: Rectal prolapse is an uncommon disease that usually requires surgical intervention. Several techniques have been described with either an abdominal or perineal approach, the latter having a higher recurrence rate. In case of irreducible and strangulated full-thickness prolapse, a perineal approach is necessary, and efforts should be made to reduce recurrence rates. CASE REPORT: A 39-year-old mentally retarded woman presented with a painful, recurrent, strangulated sigmoid prolapse following a perineal recto-sigmoidectomy (Altemeier’s procedure) for strangulated rectal prolapse 2 months previously. Examination revealed a 10-cm strangulated, prolapsed sigmoid. A laparoscopic-assisted perineal sigmoid resection with colo-anal anastomosis was carried out. The patient made an uneventful recovery and was discharged on the 6(th) postoperative day. CONCLUSIONS: This is the second report in the literature highlighting the role of laparoscopy in Altemeier’s procedure for strangulated prolapse. Laparoscopy aids assessment of sigmoid length, allows colonic mobilization, and assures that all redundant bowel is excised. This approach can reduce recurrence rate and need of further surgical interventions.