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Perineal proctosigmoidectomy is an acceptable and a safe procedure for irreducible rectal prolapse

Amir Shaban, MD Gastrointestinal and Laparoscopic Surgery, Hossam Barakat Elbohoty, MD GIT Surgery, Hossam Ramadan Mousa, MD Surgical Oncology, Tarek Mohamed Afifi Sehsah, Assistant Lecturer of General Surgery. Tanta University Hospitals

Irreducible or incarcerated rectal prolapse is a rare complication of rectal prolapse, the issue of management of rectal prolapse is controversial and the guidelines for the treatment of rectal prolapse recommends individual selection of the best proper surgical procedures based on each patient’s overall condition. However, in cases of irreducible or incarcerated rectal prolapse the surgical procedures are very limited we had five cases of irreducibility complicated chronically progressive form of complete rectal prolapse. All cases were managed conservatively at first by trial of manual reduction but failed, application of sugar was done in three from the five cases but failed and hence emergency surgery through perineal proctosigmoidectomy was done. In the period from 2013 till end of 2017 we received five patients with irreducible incarcerated rectal prolapse in Tanta University hospital. Three of them were males and the reaming two were females the median age of these patients was 43 years. The duration of irreducibility at presentation varied from 16 hour to 4 days trial of manual reduction was done in all five cases after injection of strong analgesia but failed. Two patients had patches of gangrene so no sugar application attempted. Two patients had medical morbidity one of them diabetic and the other was cardiac patient but with controlled cardiac functions. The mean length of the prolapsed rectum varied between 9-14 cm with a mean length of 11.2 cm. Two cases had patches of ulceration and gangrene, two cases with ulceration and edema, and one case with only edema. All cases subjected to perineal proctosigmoidectomy (Altemier procedure) and a covering ileostomy, levatorplasty added in only one case. The mean operative time was 83 minute. Postoperative complications occurred in two cases; one of them wound infection and the other wound infection and partial anastomotic dehiscence, the two cases successfully managed conservatively. The timing of restoration of small bowel continuity ranged from 8-24 wks with a median value of 13 wks. The period of follow up ranged from 1-3 years in which all patients were doing well except one case suffered incontinence to fluid stool. No recurrence of prolapse occurred in any case.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 91625

Program Number: P317

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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