Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 847-853
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.847
Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report
Tetsu Yamamoto, Ryoji Hyakudomi, Kiyoe Takai, Takahito Taniura, Yuki Uchida, Kazunari Ishitobi, Noriyuki Hirahara, Yoshitsugu Tajima
Tetsu Yamamoto, Ryoji Hyakudomi, Kiyoe Takai, Takahito Taniura, Yuki Uchida, Kazunari Ishitobi, Noriyuki Hirahara, Yoshitsugu Tajima, Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
Author contributions: Yamamoto T, Hyakudomi R, Takai K and Taniura T were the patient’s surgeons, reviewed the literature and contributed to manuscript drafting; Uchida Y, Ishitobi K, Hirahara N and Tajima Y reviewed the literature and contributed to manuscript drafting; all authors contributed equally to the conception, design, critical revision, and editing of this paper, and approved the final version of this study.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tetsu Yamamoto, MD, PhD, Assistant Lecturer, Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya, Izumo 693-8501, Shimane, Japan. t2t2@med.shimane-u.ac.jp
Received: October 19, 2020
Peer-review started: October 19, 2020
First decision: December 3, 2020
Revised: December 17, 2020
Accepted: December 26, 2020
Article in press: December 26, 2020
Published online: February 6, 2021
Processing time: 97 Days and 23.2 Hours
Abstract
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.

Keywords: Indocyanine green fluorescence imaging; Rectal prolapse; Altemeier operation; Young women; Mental disorder; Perineal rectosigmoidectomy; Case report

Core Tip: Rectal prolapse mainly occurs in elderly women and is rare in young women. Perineal approaches, including perineal rectosigmoidectomy (Altemeier perineal rectosigmoidectomy), are useful for not only elderly patients but also young women who desire pregnancy. However, postoperative anastomotic leakage should be considered. Recently, fluorescence imaging with indocyanine green (ICG) has provided a real-time assessment of intestinal perfusion to prevent the occurrence of anastomotic leakage after colorectal surgery. We describe here a case of a female adolescent patient with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy to prevent postoperative anastomotic leakage as well as surgery-related infertility.