Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of in...Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.展开更多
BACKGROUND Compared to traditional open surgery,laparoscopic surgery has become a standard approach for colorectal cancer due to its great superiorities including less postoperative pain,a shorter hospital stay,and be...BACKGROUND Compared to traditional open surgery,laparoscopic surgery has become a standard approach for colorectal cancer due to its great superiorities including less postoperative pain,a shorter hospital stay,and better quality of life.In 2007,Whiteford et al reported the first natural orifice trans-anal endoscopic surgery(NOTES)sigmoidectomy using transanal endoscopic microsurgery.To date,all cases of NOTES colorectal resection have included a hybrid laparoscopic approach with the use of established rigid platforms.AIM To introduce a novel technique of peroral external traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis by using only currently available and flexible endoscopic instrumentation in a live porcine model.METHODS Three female pigs weighing 25-30 kg underwent NOTES rectosigmoid resection.After preoperative work-up and bowel preparation,general anesthesia combined with endotracheal intubation was achieved.One dual-channel therapeutic endoscope was used.Carbon dioxide insufflation was performed during the operation.The procedure of trans-anal NOTES rectosigmoidectomy included the following eight steps:(1)The rectosigmoid colon was tattooed with India ink by submucosal injection;(2)Creation of gastrostomy by directed submucosal tunneling;(3)Peroral external traction using endoloop ligation;(4)Creation of rectostomy on the anterior rectal wall by directed 3 cm submucosal tunneling;(5)Peroral external traction-assisted dissection of the left side of the colon;(6)Transanal rectosigmoid specimen transection,where an anvil was inserted into the proximal segment after purse-string suturing;(7)Intracorporeal colorectal end-toend anastomosis using a circular stapler by a single stapling technique;and(8)Closure of gastrostomy using endoscopic clips.All animals were euthanized immediately after the procedure,abdominal exploration was performed,and the air-under-water leak test was carried out.RESULTS The procedure was completed in all three animals,with the operation time ranging from 193 min to 259 min.Neither major intraoperative complications nor hemodynamic instability occurred during the operation.The length of the resected specimen ranged from 7 cm to 13 cm.With the assistance of a transumbilical rigid grasper,intracorporeal colorectal,tension-free,end-to-end anastomosis was achieved in the three animals.CONCLUSION Peroral traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis is technically feasible and reproducible in an animal model and is worthy of further improvements.展开更多
Strangled rectal prolapse, the rare disease, is a proctological emergency. Its management is controversial. When it is not reducible and signs of ischemia are present, the Altemeierperineal rectosigmoidectomy remains ...Strangled rectal prolapse, the rare disease, is a proctological emergency. Its management is controversial. When it is not reducible and signs of ischemia are present, the Altemeierperineal rectosigmoidectomy remains the best treatment. This study aimed to report our experience on the management of strangled rectal prolapse about 1 case in a 45-year-old man, a holder of a rectal prolapse for 2 years. On admission, he had strangled prolapse for 24 hours with edema. After a vain attempt of manual reduction and installation of necrosis after 48 hours, he had an Altemeier rectosigmo?dectomy. The postoperative course was uneventful and the patient was discharged on the 6th postoperative day. The results were very good, after one year follow-up.展开更多
BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoi...BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoidectomy(Altemeier procedure)is useful for these patients.However,the risk of anastomotic leakage should be considered.Recently,the usefulness of fluorescence imaging with indocyanine green(ICG)to prevent anastomotic leakage was reported.We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication.The patient also suffered from rectal prolapse,approximately 3 mo before admission.She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder.Approximately 10 cm of complete rectal prolapse was observed.However,the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry.Because she had the desire to bear children in the future,she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility.We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage.Her postoperative course was uneventful,and the rectal prolapse was completely resolved.She continued to do well 18 mo after surgery,without recurrence of the rectal prolapse.CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.展开更多
A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining a...A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation.After 6 d from perineal rectosigmoidectomy, the patient,was discharged free of complications.Four days later he was readmitted in emergency for stran-gulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate.The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen,resection of the necrotic ileum,and end colostomy.The outcome of the second operation was free of complication and the patient was discharged on the 6th postoperative day.In conclusion,after Altemeier operation prolonged straining at defecation should be carefully展开更多
Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is requ...Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.展开更多
文摘Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.
基金Supported by Young and Middleaged Mainstay Talent Training Program of Fujian Provincial Health System,China,No.2014-ZQN-ZD-6.
文摘BACKGROUND Compared to traditional open surgery,laparoscopic surgery has become a standard approach for colorectal cancer due to its great superiorities including less postoperative pain,a shorter hospital stay,and better quality of life.In 2007,Whiteford et al reported the first natural orifice trans-anal endoscopic surgery(NOTES)sigmoidectomy using transanal endoscopic microsurgery.To date,all cases of NOTES colorectal resection have included a hybrid laparoscopic approach with the use of established rigid platforms.AIM To introduce a novel technique of peroral external traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis by using only currently available and flexible endoscopic instrumentation in a live porcine model.METHODS Three female pigs weighing 25-30 kg underwent NOTES rectosigmoid resection.After preoperative work-up and bowel preparation,general anesthesia combined with endotracheal intubation was achieved.One dual-channel therapeutic endoscope was used.Carbon dioxide insufflation was performed during the operation.The procedure of trans-anal NOTES rectosigmoidectomy included the following eight steps:(1)The rectosigmoid colon was tattooed with India ink by submucosal injection;(2)Creation of gastrostomy by directed submucosal tunneling;(3)Peroral external traction using endoloop ligation;(4)Creation of rectostomy on the anterior rectal wall by directed 3 cm submucosal tunneling;(5)Peroral external traction-assisted dissection of the left side of the colon;(6)Transanal rectosigmoid specimen transection,where an anvil was inserted into the proximal segment after purse-string suturing;(7)Intracorporeal colorectal end-toend anastomosis using a circular stapler by a single stapling technique;and(8)Closure of gastrostomy using endoscopic clips.All animals were euthanized immediately after the procedure,abdominal exploration was performed,and the air-under-water leak test was carried out.RESULTS The procedure was completed in all three animals,with the operation time ranging from 193 min to 259 min.Neither major intraoperative complications nor hemodynamic instability occurred during the operation.The length of the resected specimen ranged from 7 cm to 13 cm.With the assistance of a transumbilical rigid grasper,intracorporeal colorectal,tension-free,end-to-end anastomosis was achieved in the three animals.CONCLUSION Peroral traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis is technically feasible and reproducible in an animal model and is worthy of further improvements.
文摘Strangled rectal prolapse, the rare disease, is a proctological emergency. Its management is controversial. When it is not reducible and signs of ischemia are present, the Altemeierperineal rectosigmoidectomy remains the best treatment. This study aimed to report our experience on the management of strangled rectal prolapse about 1 case in a 45-year-old man, a holder of a rectal prolapse for 2 years. On admission, he had strangled prolapse for 24 hours with edema. After a vain attempt of manual reduction and installation of necrosis after 48 hours, he had an Altemeier rectosigmo?dectomy. The postoperative course was uneventful and the patient was discharged on the 6th postoperative day. The results were very good, after one year follow-up.
文摘BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoidectomy(Altemeier procedure)is useful for these patients.However,the risk of anastomotic leakage should be considered.Recently,the usefulness of fluorescence imaging with indocyanine green(ICG)to prevent anastomotic leakage was reported.We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication.The patient also suffered from rectal prolapse,approximately 3 mo before admission.She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder.Approximately 10 cm of complete rectal prolapse was observed.However,the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry.Because she had the desire to bear children in the future,she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility.We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage.Her postoperative course was uneventful,and the rectal prolapse was completely resolved.She continued to do well 18 mo after surgery,without recurrence of the rectal prolapse.CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.
文摘A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation.After 6 d from perineal rectosigmoidectomy, the patient,was discharged free of complications.Four days later he was readmitted in emergency for stran-gulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate.The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen,resection of the necrotic ileum,and end colostomy.The outcome of the second operation was free of complication and the patient was discharged on the 6th postoperative day.In conclusion,after Altemeier operation prolonged straining at defecation should be carefully
文摘Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.
