A massive transrectal herniation of terminal ileal loops as a complication of a recent STARR procedure

Manuela Montatore; Gianmichele Muscatella; Federica Masino; Rossella  Gifuni; Rossella  Carpentiere; Andrea Fares Bucci; Giuseppe Guglielmi

doi:10.23750/abm.v95i4.15337

A massive transrectal herniation of terminal ileal loops as a complication of a recent STARR procedure

Authors

Manuela Montatore Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy
Gianmichele Muscatella Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy
Federica Masino Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy
Rossella Gifuni Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy
Rossella Carpentiere Radiology Unit, “Dimiccoli” Hospital, Viale Ippocrate 15, 70051, Barletta (BT), Italy
Andrea Fares Bucci Radiology Unit, “Dimiccoli” Hospital, Viale Ippocrate 15, 70051, Barletta (BT), Italy
Giuseppe Guglielmi Department of Clinical and Experimental Medicine, Foggia University School of Medicine

DOI: https://doi.org/10.23750/abm.v95i4.15337

Keywords:

STARR complications, CT, Diagnostic procedure, rectum herniation, protrusion terminal-ileal loops, emergency

Abstract

This case report describes the complications of a recent STARR procedure (Stapled Trans-Anal Rectal Resection), in a female patient with a rectal prolapse. The protrusion of the rectum through the anus is a defining feature of the disorder known as rectal prolapse. Rectal prolapse therapy frequently involves the STARR procedure, a minimally invasive surgical approach. Post-operative problems, however, can occur and require extra treatments. This case report discusses the radiological results after a CT and the following treatments of a patient, who had severe complications after a STARR surgery. Less than 48 hours after surgery, the patient arrives in the Radiology Department, totally non-cooperative to do a CT, due to the worsening clinical condition into a complete shock status. The radiological findings revealed a significant trans-rectal herniation of the terminal ileal loops, which was also visible from the outside, so the patient underwent an urgent surgical intervention to reposition the loops and repair the prolapsed segment, to avoid severe consequences. After the procedure, the patient's symptoms decreased, and she was released after a long hospitalization with a favorable prognosis. To diagnose these complications and identify proper management methods that could prevent serious further consequences, up until the patient's death, radiological imaging, such as CT with contrast medium, and corrective surgery is essential.

References

Segal J, McKeown DG, Tavarez MM. Rectal Prolapse. 2023 Jul 31. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol. 2008; 12(1):7-19. doi: 10.1007/s10151-008-0391-0.

Zhang B, Ding JH, Yin SH, et al. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol. 2010; 16(20):2542-8. doi: 10.3748/wjg. v16.i20.2542.

Tuncer A, Akbulut S, Ogut Z, et al. Management of irreducible giant rectal prolapse: A case report and literature review. Int J Surg Case Rep. 2021; 88:106485. doi: 10.1016/j.ijscr.2021.106485.

Oruc M, Erol T. Current diagnostic tools, and treatment modalities for rectal prolapse. World J Clin Cases. 2023; 11(16):3680-3693. doi: 10.12998/wjcc. v11.i16.3680.

Wallace SL, Enemchukwu EA, Mishra K, et al. Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J. 2021; 32(9):2401-2411. doi: 10.1007/s00192-021-04778-y.

Martellucci J, Talento P, Carriero A. Early complications after stapled transanal rectal resection were performed using the Contour® Transtar™ device. Colorectal Dis. 2011; 13(12):1428-31. doi: 10.1111/j.1463-1318.2010.02466. x.

Bordeianou L, Hicks CW, Kaiser AM, et al. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg. 2014; 18(5):1059-69. doi: 10.1007/s11605-013-2427-7.

Farouk R, Bhardwaj R, Phillips RK. Stapled transanal resection of the rectum (STARR) for the obstructed defecation syndrome. Ann R Coll Surg Engl. 2009; 91(4):287-91. doi: 10.1308/003588409X428315.

Gallo G, Trompetto M. Complete rectal prolapse: still a lot of work to do. Tech Coloproctol. 2019; 23:287–288.

Lin HC, Chen HX, Huang L, et al. Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection (STARR) in patients with obstructed defecation syndrome. Gastroenterol Rep (Oxf). 2018; 6(4):270-276. doi: 10.1093/gastro/goy034.

Purnama A, Rudiman R, Perinandika T. A 54-Year-Old Man with a Large Rectal Prolapse Treated with Perineal Proctosigmoidectomy with Levatorplasty (Altemeier Procedure): Presentation of Case and Review of Literature. Am J Case Rep. 2023; 24: e939508. doi: 10.12659/AJCR.939508.

Tou S, Brown SR, Nelson RL. Surgery for complete (full thickness) rectal prolapse in adults. Cochrane Database Syst Rev. 2015; 2015(11): CD001758. doi: 10.1002/14651858.CD001758.

Naldini G, Martellucci J, Rea R, et al. Tailored prolapse surgery for the treatment of hemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus. Int J Colorectal Dis. 2014; 29(5):623-9. doi: 10.1007/s00384-014-1845-7.