Pelvic Sepsis Secondary to Necrotic Coloanal Anastomosis After Perineal Proctosigmoidectomy Leading to Emergent Abdominoperineal Resection - A Rare Case and Complication

Sep 30, 2026

Abdominoperineal resection (APR) is a complex procedure that removes the anal canal, sphincter complex, rectum, and a segment of sigmoid colon, creating a permanent end colostomy. Indications include low rectal cancers with nonsparing sphincters and selected refractory or recurrent anal malignancies, as well as severe perianal Crohn’s disease, complex anorectal fistulae, or major anus/rectum trauma. APR carries a high complication burden, often requiring intensive perioperative assessment. This report presents a rare emergent APR after pelvic sepsis from necrotic rectum and colon following a prior emergent Altemeier procedure, supported by a literature review showing only one prior case.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Incarcerated rectal prolapse and pelvic sepsis risk

Altemeier procedure (perineal proctosigmoidectomy) and its limitations

APR indications, procedure, and technical complexity

Review began 11/14/2025 Review ended 12/02/2025 Published 12/09/2025 © Copyright 2025 Yerramilli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98821 Open Access Case Report Pelvic Sepsis Secondary to Necrotic Coloanal Anastomosis After Perineal Proctosigmoidectomy Leading to Emergent Abdominoperineal Resection: A Rare Case and Complication Prathusha Yerramilli 1, Michael Boysen 2, Kristina Fioretti 3, Stevie-Jay Stapler 3 1. Surgery, Trinity Health Ann Arbor Hospital, Ypsilanti, USA 2. General Surgery, Trinity Health Ann Arbor Hospital, Ypsilanti, USA 3. Colorectal Surgery, Trinity Health Ann Arbor Hospital, Ypsilanti, USA Corresponding author: Prathusha Yerramilli, [prathusha.yerramilli@gmail.com](prathusha.yerramilli@gmail.com) Abstract Abdominoperineal resection (APR) is a surgical procedure that involves the complete removal of the anal canal, anal sphincter complex, rectum, and a portion of the sigmoid colon with creation of an end colostomy. This procedure is primarily indicated for patients with low rectal cancers where the anal sphincters cannot be spared and anal cancers refractory to chemoradiation or recurrent anal cancers. It can also be performed in patients with severe perianal Crohn’s disease, complex anorectal fistulae, or patients with severe trauma to the anus/rectum where the sphincter complex is significantly affected. This is a complex procedure with a high complication rate, and patients generally undergo extensive perioperative planning and assessment to optimize a positive outcome. In this report, we describe a rare case of emergent APR in a patient who presented with pelvic sepsis secondary to necrotic rectum and colon after a prior emergent Altemeier procedure at another hospital. A thorough literature review has revealed only one prior documented case of emergent APR. Categories: Other, General Surgery Keywords: abdominoperineal resection (apr), altemeier procedure, pelvic sepsis, perineal proctosigmoidectomy, robotic colorectal surgery Introduction Incarcerated rectal prolapse is a severe form of full-thickness rectal prolapse in which the prolapsed segment becomes irreducible, leading to venous congestion, edema, and potential strangulation. This condition occurs most commonly in elderly or frail patients with chronic constipation, weakened pelvic floor musculature, and comorbidities that impair tissue integrity. When blood flow becomes compromised, the prolapsed rectum is at risk of ischemia, necrosis, or even perforation, which can rapidly progress to pelvic sepsis if not addressed. Consequently, prompt surgical intervention is required, particularly in elderly or medically fragile patients who are at greatest risk for these life-threatening complications [1] . Perineal proctosigmoidectomy, also known as the Altemeier procedure, is a relatively safe and effective option for full-thickness rectal prolapse, especially in frail or elderly patients for whom an abdominal approach may be contraindicated. It can be performed under regional anesthesia, is associated with low postoperative morbidity, minimal pain, and a short recovery period. However, its principal limitation is anon-negligible recurrence rate and potential complications, which include anastomotic dehiscence, pelvic hematoma, abscess formation, and anal stricture. Overall, the Altemeier procedure remains a valuable surgical alternative for medically fragile patients, but it is not without risk, particularly in cases of incarcerated prolapse where vascular compromise, poor tissue quality, or subsequent interventions such as arterial embolization can predispose to anastomotic failure and pelvic sepsis [2] . Such complications can require complex surgical intervention to manage, as

FAQs

What is abdominoperineal resection (APR) and what outcome does it create?

APR involves removing the anal canal, anal sphincter complex, rectum, and part of the sigmoid colon, resulting in a permanent end colostomy to divert stool.

Why can pelvic sepsis develop after rectal prolapse and necrosis?

With incarcerated rectal prolapse, impaired blood flow can lead to ischemia and necrosis; if not addressed promptly, progression can rapidly result in pelvic sepsis.

What complication did the authors describe that led to emergent APR?

The case describes emergent APR for pelvic sepsis secondary to necrotic rectum and colon after a prior emergent Altemeier procedure, with only one previously documented emergent APR case found in the literature.

Sep 30, 2026

Uploaded by mieayamfan