Perineal Proctosigmoidectomy with Covering Ileostomy is an Acceptable and Safe Procedure for Irreducible Rectal Prolapse

Special Article - Proctosigmoidectomy Surgery

Austin J Surg. 2019; 6(11): 1188.

Perineal Proctosigmoidectomy with Covering Ileostomy is an Acceptable and Safe Procedure for Irreducible Rectal Prolapse

Abdelhamid AF¹*, Elsheikh M¹, Hablus MA¹ Barakat H¹ and Youssef T²

¹Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine, Tanta University, Egypt

²Colorectal Surgery Department, Faculty of Medicine, Ain Shams University, Egypt

*Corresponding author: Abdelhamid AF, Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Faculty of Medicine, Tanta University, Egypt

Received: April 16, 2019; Accepted: May 07, 2019; Published: May 14, 2019

Abstract

Irreducible or incarcerated rectal prolapse is a rare complication of rectal prolapse, the management of rectal prolapse is controversial and the guidelines for the treatment of rectal prolapse recommend individual selection of the best proper surgical procedures (which are limited) based on each patient’s overall condition. Our study included twenty cases of complicated irreducible complete rectal prolapse. Conservative treatment with the strategy of manual reduction was not tried in ten patients because patches of gangrene and ulceration were developed at their presentation and so, they subjected to urgent perineal proctosigmoidectomy surgery. The remaining ten patients were managed conservatively by trial of manual reduction that failed in five patients who were also subjected to perineal proctosigmoidectomy. In all operated cases, we added a protective covering ileostomy. Time of closure of illoestomy was variable according to each case. The overall results are satisfactory. Early Complications occurred in 2 cases and late complications in 3 cases.

Keywords: Colorectal surgery; Proctosigmoidectomy surgery; Illeostomy

Introduction

Incarcerated complete rectal prolapse is an uncommon surgical emergency. It is usually the outcome of a neglected longstanding reducible prolapse. Early in the course of a rectal prolapse, the anal protrusion may be spontaneously reducible. With time, it requires manual manipulation to achieve reduction. If this condition remains unattended, it could ultimately progress to irreducibility and incarceration. This situation if untreated carries high risk for the prolapsed rectum for ulceration, bleeding, strangulation, gangrene and eventual rupture [1].

In the absence of a formal trial, it is very difficult to be certain which procedure is best in the emergency setting. Is it the safer perineal proctosigmoidectomy with its high recurrence rate, or the more effective but potentially risky transabdominal procedures: either rectopexy or resection and fixation? Surgeons seem to choice or prefer the safety of a perineal approach, although the literature at present is far from conclusive [2,3].

Aim of the Work

The purpose of this study was to report our experience on the management of the irreducible rectal prolapse treated by the Altemeier perineal proctosgmoidectomy technique in 15 patients with addition of transient protective ileostomy.

Patients and Methods

This study included patients with complete irreducible rectal prolapse during a period of 4 years at Tanta University Hospitals and Ain shams university hospitals. All cases data were collected with great attention to established irreducibility, demographic data, management and follow up. Our protocol in management of irreducible rectal prolapse was conservative treatment unless there were patches of gangrene, ulceration or bleeding, (Figure 1) which was found from the first in 10 cases. The initial management included a trial of manual reduction under cover of good sedation in operating theatre, if this failed sugar was applied (about 25 grams fine powdered sugar diluted with saline) over the prolapsed area with retrial of manual reduction in the next 24hour. If all previously mentioned procedures failed, perineal proctosigmoidectomy procedure with covering ileostomy was done (in 5 cases with failure of conservative measures).