Publication:

Managing emergent irreducible rectal prolapse: pros and pitfalls of Altemeier procedure and review of perineal strategies

Rectal prolapse is a debilitating condition predominantly affecting older adults and may be exacerbated by chronic constipation, frailty, or psychiatric comorbidities. Perineal approaches, including the Altemeier procedure, offer an effective treatment option for selected patients, particularly when abdominal surgery carries elevated risk. We report the case of a 62-year-old woman with schizophrenia, hemorrhoidal disease, and chronic constipation who presented with a large, irreducible full-thickness rectal prolapse of several years’ duration and underwent emergency perineal rectosigmoidectomy. A 23-cm rectosigmoid segment was resected and a hand-sewn coloanal anastomosis performed. Histopathological examination showed mucosal hemorrhage, ulceration, and vascular congestion without dysplasia or malignancy. Postoperative recovery was uneventful, with restoration of bowel function by postoperative day 8 and discharge on day 9. Transient flatus incontinence resolved spontaneously. At two-year follow-up, the patient remained asymptomatic, without recurrence, constipation, or significant incontinence. However, recurrence of rectal prolapse was documented five years after surgery and additional post-recurrence evaluation will be performed.Rectal prolapse is an uncommon but debilitating condition, particularly in patients with comorbidities such as chronic constipation or psychiatric disorders. Incarcerated prolapse requires prompt surgical intervention; in this case, the Altemeier procedure was chosen due to irreducibility, chronicity, and patient frailty. Postoperative recovery was uneventful, with restoration of bowel function and good two-year functional outcomes. Although recurrence remains a concern—especially with large or long-standing prolapses—the procedure is a pragmatic and reproducible option for high-risk patients. The Altemeier procedure is an effective option for irreducible rectal prolapse, offering good functional outcomes in high-risk patients. Long-term recurrence remains possible, highlighting the need for individualized management and ongoing postoperative follow-up.