TREATMENT OF IRREDUCIBLE RECTAL PROLAPSE BY PERINEAL RECTOSIGMOIDECTOMY: TECHNICAL DETAILS EVERY SPECIALIST SHOULD KNOW

Introduction/Case Presentation A 77-year-old female patient, hypertensive, diabetic, and cardiopathic, has been experiencing pain, constipation, anal incontinence, and difficulty mobilizing due to rectal prolapse for the past 2 years. Upon proctological examination, the patient presented with irreducible rectal prolapse approximately 10 cm in length, associated with fungal perianal dermatitis. Colonoscopy revealed multiple diverticula in the sigmoid colon, with no other lesions. Due to the patient's clinical context, classified as frail elderly with significant comorbidities, a decision was made to address the rectal prolapse with perineal rectosigmoidectomy.

Objective The objective of the video is to discuss the technical details of perineal rectosigmoidectomy, illustrating the step-by-step method, from patient positioning to surgical technique and postoperative results.

Conclusion The patient had a good postoperative evolution, with intestinal transit present on the second postoperative day. Currently, she is under outpatient follow-up, with bowel movements every two days and no signs of recurrence of the pathology. Perineal rectosigmoidectomy is a less invasive procedure compared to the abdominal approach. It is primarily indicated for elderly patients with comorbidities who have contraindications for abdominal access, as it can be performed under neuro-axial anesthesia (spinal or epidural anesthesia). As a disadvantage, it involves the resection of the rectal reservoir and has a higher recurrence rate compared to abdominal techniques, but it should be part of the surgical repertoire of the coloproctologist.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025