The utility of the Altemeier procedure in strangulated rectal procidentia secondary to rectal cancer. A case report

• Published in: International journal of surgery case reports 2022-01, Vol.90, p.106741-106741, Article 106741
• Main Authors: Chase, Courtenay, Griffith, Sahle, Doyle, Alex
• Format: Article
• Language: English
• Subjects: Altemeier procedure; Case Report; Hepatic resection; Rectal cancer; Rectal procidentia; Rectal prolapse
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.106741

Altemeier rectosigmoidectomy has been cited in the literature as a suitable approach for incarcerated rectal prolapse when a large segment of bowel is involved. However, the literature is devoid of cases that employed the technique as an oncological procedure for rectal carcinoma. For this reason, this case report heralds a new perspective on an old technique. We describe the case of a male in his 6th decade who presented with stage four rectal cancer. Computed tomography imaging showed a rectal mass at the rectosigmoid junction with pelvic lymphadenopathy and a solitary hepatic lesion in segment two of the liver. While admitted to the hospital a 16 cm segment of bowel containing the mass prolapsed and became incarcerated, eventually becoming necrotic. A modification of the Altemeier procedure was performed along with a diverting ileostomy and hepatic wedge resection of the solitary metastases. Histological assessment of the surgical specimens confirmed that adequate resection margins were obtained with one of twenty-one lymph nodes positive for malignancy. He is currently being followed up in the outpatient oncology clinic and has commenced adjuvant chemotherapy. Synchronous excision of rectal carcinoma with hepatic metastasectomy is a feasible surgery even in the emergency setting and can offer improved patient survival. The combination of both an abdominal and perineal approach was suitable for this patient given his improved quality of life and negative pathological margins. •Rectal prolapse can be the first presentation of rectal cancer.•Strangulated rectal procidentia should be addressed by the perineal route.•Altemeier procedure can be utilized for oncological resection of rectal cancer.•Low volume liver resection is feasible without adjustment of central venous pressure.