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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(01): 037-041
DOI: 10.1055/s-0041-1724060
Original Article

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

Cirurgia para prolapso de estoma complicado: A técnica de Altemeier é uma opção? Um relato de três casos
Tamer R. Alalfy 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Yasser A. Orban 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Mohammed Algazar 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ahmed Farag 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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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 The modified Altemeier technique may be a valid therapeutic modality in the setting of complicated prolapsed stoma.

Resumo

Introdução A incidência de prolapso de estoma varia de 2 a 22%. Os fatores de risco incluem colostomia, comprimento curto do estoma, obesidade, cirurgias de emergência, e marcação não adequada (ou até mesmo ausente) do sítio pré-operatório para o estoma. Prolapso de estoma complicado e associado a irritação grave de mucosa, alterações isquêmicas, ou sangramento requer intervenção cirúrgica.

Objetivo Descrever o uso da técnica de Altemeier para o manejo de prolapso de estoma complicado após fracasso das medidas médicas locais e da redução manual.

Métodos Série de casos de três pacientes com histórico de ressecção abdominoperineal de câncer retal e colostomia terminal permanente apresentaram prolapso irredutível do estoma. Com o fracasso das medidas locais e da redução manual, fez-se necessária intervenção cirúrgica de emergência usando a técnica de Altemeier modificada.

Resultados A técnica de Altemeier modificada é simples e apresenta risco baixo de complicações operatórias e pós-operatórias, além de possibilitar uma recuperação precoce, com menor risco de recorrência durante os 6 primeiros meses após o reparo.

Conclusão A técnica de Altemeier modificada pode ser uma modalidade terapêutica válida em casos de prolapso de estoma complicado.

Keywords

Altemeier technique - stoma - abdominoperineal resection - end colostomy - irreducible prolapse

Palavras-chave

técnica de Altemeier - estoma - ressecção abdominoperineal - colostomia terminal - prolapso irredutível


Publication History

Received: 03 July 2020

Accepted: 18 August 2020

Article published online:
19 March 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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