Surgery for Complicated Stomal Prolapse: Is the Altemeier Technique an Option? A Report of Three Cases

Alalfy, Tamer R.; Orban, Yasser A.; Algazar, Mohammed; Farag, Ahmed

doi:10.1055/s-0041-1724060

Abstract

Introduction

The incidence of stomal prolapse ranges from 2% to 22%. The risk factors include colostomy, the short length of the stoma, obesity, emergency surgery, and the improper (or even absence of) marking of the preoperative site for the stoma. Complicated stomal prolapse associated with severe mucosal irritation, ischemic changes, or bleeding requires surgical intervention.

Objective

To describe the use of the Altemeier technique in the management of cases of complicated prolapsed stoma after failure of the local medical measures and manual reduction.

Methods

Case series of three patients with past history of abdominoperineal resection of rectal cancer and permanent end colostomy presented with irreducible prolapse of the stoma. After the failure of the local measures and manual reduction, urgent surgical intervention using the modified Altemeier technique was necessary.

Results

The modified Altemeier technique is simple, presents low risk of operative and postoperative complications, besides enabling an early recovery, with a lower risk of recurrence during the first 6 months after the repair.

Conclusion

Themodified Altemeier technique may be a valid therapeutic modality in the setting of complicated prolapsed stoma.

Keywords:
Altemeier technique; stoma; abdominoperineal resection; end colostomy; irreducible prolapse

[1] Address for correspondence Mohammed Algazar, MD, Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt (e-mail: drmohammedezzat4@gmail.com).

	Patient 1	Patient 2	Patient 3
Age (years)	40	52	60
Gender	Female	Male	Male
Primary disease	Cancer of the lower rectum	Anorectal cancer	Anorectal cancer
Staging of the primary disease	T3N2M0	Not known	T3N0M0
Primary procedure	Abdominoperineal resection	Abdominoperineal resection	Abdominoperineal resection
American Society of Anesthesiologists (ASA) physical status classification system	ASA I	ASA I	ASA II
Type of stoma	End-colostomy	End-colostomy	End-colostomy
Time of the prolapse after the primary surgery (months)	7	5	6

	Patient 1	Patient 2	Patient 3
Duration of the procedure (min)	60	65	55
Intraoperative blood loss (ml)	50	30	30
Sutures used	Polyglactin 910 3/0
Length of hospital stay (days)	3	2	2
Postoperative complications	None
Follow-up (months)	6

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