Strangled Rectal Prolapse in Relation to Two Observations at the University Hospital Center of Conacry

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Introduction: Rectal prolapse is defined as the full or partial thickness concentric protrusion of the rectum or rectosigmoid via the anus. This is a growing clinical concern that is usually found in elderly patients. The aim of the study was to report the results of surgery in two patients operated on for strangulated rectal prolapse using the ALTEMEIER technique and to review the literature. Observation 1: 78-year-old grandmother is admitted for a painful and irreducible rectal protrusion evolving for 72 hours. Given the failure of self-medication with poultices, she consults our service. In this history, she had stubborn constipation. She was a lucid patient. We saw a voluminous perineal mass, irreducible necrotic in places, with a polyp at its top. The examination of other devices as well as the biological assessment did not present any particularity. A rectosigmoidectomy with colo-anal anastomosis was straightforward. The patient was without complications six months later. Anatomo-pathological examination of the surgical specimen was not available. Observation 2: A 51-year-old merchant, admitted for a painful, irreducible rectal protrusion evolving for 48 hours. He consults after several unsuccessful attempts at self-reduction. He had stubborn constipation and bilateral inguinal herniorrhaphy as a history. Examination showed a large perineal mass with ischemic necrosis. Elsewhere it was unremarkable. Paraclinical assessment revealed hyperleukocytosis and accelerated ESR. The diagnosis of total strangulated rectal prolapse was made. Under spinal anesthesia, a rectosigmoidectomy with colo-anal anastomosis was performed immediately. The patient seen again six months later had no complications. Conclusion: strangulated rectal prolapse is a surgical emergency. Its PEC takes into account the patient's condition and the surgeon's experience. Perineal resection is the preferred surgical option in emergencies although its recurrence rate is higher compared to its cure through the abdominal route.

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