# Unveiling the Hidden: A Case Report on Altemeier’s Surgical Triumph in Rectal Prolapse With Involvement of the Small Bowel

## TL;DR

A 26-year-old man with a severe rectal prolapse involving the small bowel required Altemeier's surgery when conservative methods failed.

## Contribution

This case report highlights the rare use of Altemeier's procedure in a young patient with irreducible rectal prolapse and small bowel involvement.

## Key findings

- The patient's rectal prolapse could not be reduced even under spinal anesthesia.
- Small bowel loops were found during surgery along with the prolapsed rectum and sigmoid colon.
- Altemeier's procedure was successfully used in a young patient despite typically being reserved for elderly individuals.

## Abstract

Full-thickness rectal prolapse is a condition where the rectum or rectosigmoid protrudes through the anus. This condition can severely impact quality of life, requiring accurate diagnosis and treatment. Small bowel involvement is rare. This case report presents a 26-year-old male patient with complete rectal prolapse that could not be reduced through conservative management. Due to the irreducibility of the prolapse, even under spinal anesthesia, Altemeier's repair was ultimately performed. During surgery, loops of the small intestine were found along with the prolapsed segment of the rectum and sigmoid colon. Surgical management of rectal prolapse includes abdominal approaches such as laparoscopic or open ventral mesh rectopexy for a carefully selected subset of younger patients and perineal approaches such as Delorme's and Alteimeier's for elderly patients. In this case, despite the patient’s young age, Altemeier's procedure was chosen due to the irreducibility of the prolapse. This case highlights the necessity of tailored surgical approaches for rectal prolapse. Individualized patient care and thorough evaluation of surgical options are crucial in managing this condition, ensuring the best possible patient outcomes.