Complicated incarcerated rectal prolapse: A surgical challenge in an elderly patient on antiplatelet agents
Complicated incarcerated rectal prolapse: A surgical challenge in an elderly patient on antiplatelet agents
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DOI：
10.4066/amj.2010.428
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发表时间：
2010-01-01
影响因子：
--
通讯作者：
Berney, C. R.
中科院分区：
文献类型：
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作者：
Berney, C. R.
完全性直肠脱垂是一种令人痛苦的疾病，表现为直肠通过肛门括约肌机制的全层突出。急性直肠脱垂的嵌顿和绞窄是一种相当罕见的实体，代表外科急诊。我们报告一个罕见的情况下，一个80岁的妇女抗血小板药物（氯吡格雷）提出了急性肠梗阻继发于绞窄环的小肠，陷入一个不可还原的出血直肠脱垂。她需要进行紧急经会阴小肠切除术和直肠乙状结肠切除术，结肠肛门吻合术（Altemeier手术），随后进行腹腔镜粘连分离，控制小肠吻合术和形成功能障碍性环状结肠造口术。患者术后恢复顺利。由于她的结肠造口关闭五个月后，她的排便恢复正常，她否认有任何残余incontinence.This情况下是一个非常不寻常的介绍复杂的急性直肠脱垂成功地处理与微创手术方法，结合会阴肠切除沿着与腹腔镜。与择期手术相比，急诊手术的术后并发症发生率往往更高。此外，随着更有效的抗血小板药物（如氯吡格雷）的广泛使用，出现早期术前或术后出血的风险增加，可能会显著恶化患者的结局。只要有可能，在紧急情况下，应始终尝试计划更“保守”的手术方法，这在我们的病例中得到了清楚的证明。
Complete rectal prolapse is a distressing condition that represents full-thickness protrusion of the rectum through the anal sphincters mechanism. Incarceration and strangulation of an acute rectal prolapse is a rather unusual entity that represents a surgical emergency. We report a rare case of an 80-year-old woman on antiplatelet drug (Clopidogrel) presenting with acute bowel obstruction secondary to a strangulated loop of small bowel, entrapped in an irreducible bleeding rectal prolapse. She required emergency transperineal small bowel resection and proctosigmoidectomy with colo-anal anastomosis (Altemeier's procedure) followed up by laparoscopic division of adhesions, control of small bowel anastomosis and formation of a defunctioning loop colostomy. The patient had an uneventful post-operative recovery. Since closure of her colostomy five months later her bowel movements are back to normal and she denies any residual incontinence.This case is a very unusual presentation of a complicated acute rectal prolapse dealt successfully with minimally invasive surgical approach that combined perineal bowel resections along with laparoscopy. Emergency procedures tend to have higher rates of post-operative complications as compared to elective ones. Furthermore, with the widen use of more efficient antiplatelet agents such as Clopidogrel, there is an increased risk of encountering early per- or post-operative bleeding that might significantly worsen patients' outcome. Whenever possible, a planed more 'conservative' surgical approach should always be attempted in emergency situations as clearly demonstrated in our case.