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Sepsis after the Altemeier procedure: A case report
Jiameng Zhu1, Lin Liu1, Hezhai Yin1,2
1Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
Rationale:
Anastomotic leakage represents the most critical complication following the Altemeier procedure. However, sepsis resulting from anastomotic leakage has been rarely reported in the literature.
Patient Concerns:
A 53-year-old male with chronic obstructive pulmonary disease and rectal prolapse underwent the Altemeier procedure. On postoperative day 4, he developed sepsis secondary to anastomotic leakage.
Diagnoses:
The patient's condition deteriorated after the Altemeier procedure, presenting with sepsis, anastomotic leakage, presacral infection, and acute exacerbation of chronic obstructive pulmonary disease.
Interventions:
Terminal ileostomy was performed, and a self-designed double-lumen irrigation-drainage catheter was placed at the anal anastomotic site for irrigation and drainage to control the source of infection. Concurrent intravenous antimicrobial therapy with meropenem and levofloxacin was administered.
Outcomes:
22 days after the terminal ileostomy procedure, procalcitonin and C-reactive protein levels normalized, and the patient was discharged. At the 4-month follow-up, colonoscopy revealed complete healing of the anastomosis, and successful ileostomy reversal surgery was subsequently performed.
Lessons:
For patients with rectal prolapse who have other comorbid infections or malnutrition, thorough preoperative assessment before the Altemeier procedure is crucial for preventing severe anastomotic leakage.
Insights
Sepsis from anastomotic leakage after the Altemeier procedure is rare. Early intervention with ileostomy and targeted therapy successfully treated a patient with rectal prolapse and sepsis.
Area of Science:
- Gastroenterology
- Surgical Complications
- Infectious Disease
Background:
- Anastomotic leakage is a critical complication of the Altemeier procedure.
- Sepsis secondary to anastomotic leakage is infrequently reported.
Purpose of the Study:
- To report a rare case of sepsis resulting from anastomotic leakage after the Altemeier procedure.
- To highlight the management of severe sepsis and anastomotic leakage in a patient with rectal prolapse and comorbidities.
Main Methods:
- A patient with rectal prolapse underwent the Altemeier procedure and subsequently developed sepsis and anastomotic leakage.
- Management involved terminal ileostomy, irrigation-drainage catheter placement, and broad-spectrum antibiotics (meropenem and levofloxacin).
Main Results:
- The patient's sepsis and infection markers (procalcitonin, C-reactive protein) resolved within 22 days.
- Complete anastomotic healing was confirmed by colonoscopy at 4 months, allowing for successful ileostomy reversal.
Conclusions:
- Thorough preoperative assessment is vital for patients with rectal prolapse and comorbidities to prevent severe anastomotic leakage.
- Aggressive source control and antimicrobial therapy are crucial for managing sepsis post-Altemeier procedure.
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