Abstract
IntroductionMore than 80% of patients with full-thickness rectal prolapse have co-existing fecal incontinence. Choosing the ideal surgical strategy is always a difficult task. We combined an Altemeier rectosigmoid resection with anal dynamic graciloplasty to provide a functional neosphincter. We found no published reports describing this surgical association.Case presentationWe report the case of a 72-year-old Caucasian woman with full-thickness rectal prolapse associated with fecal incontinence from severe neuromuscular damage.ConclusionCombined dynamic graciloplasty and an Altemeier operation could be a valid therapeutic option in patients with severe rectal prolapse with fecal incontinence from severe neurogenic damage.
Highlights
More than 80% of patients with full-thickness rectal prolapse have co-existing fecal incontinence
Ultrasonography documents a lesion involving the internal or external anal sphincter or both in 71% of patients, while in the remaining 29% incontinence arose from marked anorectal sphincter complex weakness related to severe pudendal neuropathy or to excessive internal sphincter inhibition secondary to the prolapse-associated chronic stimulation of the inhibitory anorectal reflex [2]
In a patient who presented recently with full-thickness rectal prolapse associated with fecal incontinence from severe neuromuscular damage, we combined an Altemeier rectosigmoid resection with anal dynamic graciloplasty to provide a functional neosphincter
Summary
More than 80% of patients with full-thickness rectal prolapse have co-existing fecal incontinence [1]. In a patient who presented recently with full-thickness rectal prolapse associated with fecal incontinence from severe neuromuscular damage, we combined an Altemeier rectosigmoid resection with anal dynamic graciloplasty to provide a functional neosphincter. This combined procedure has the advantage of avoiding the risk that correcting the rectal prolapse alone might lead to the removal of the terminal obstacle, namely the rectosigmoid intussusception, and worsening fecal incontinence. The leads connecting the neurostimulator to the gracile muscle were tunnelled subcutaneously This entailed constructing a temporary transverse colostomy to minimize the risk of infections involving the perianal accesses that can damage the neosphincter or cause its disinsertion. The patient was already continent for solids (Wexner incontinence score 9) and could switch the pacemaker device on and off without help
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