Perineal Approach to External Rectal Prolapse: The Altemeier Procedure

  • Donato F. Altomare
  • Marcella Rinaldi


The perineal approach to treating full-thickness external rectal prolapse was adopted in the first attempt to cure this condition due to the risk posed by the intraperitoneal approach in the preantibiotic era and before adequate anaesthesiological support became available. The first rectosigmoidectomy reported in the literature was an emergency amputation of the rectum for an irreducible rectal prolapse with gangrene, performed by Auffret in 1882 [1]. Then in 1888, Mikulicz [2] described a series of six cases of rectal amputation for incarcerated complete rectal prolapse, with no mortality or recurrence, so that the operation was long associated to his name (as reported in Gabriel’ textbook on rectal surgery, dated 1949 [3]). Following other occasional reports, Miles [4] made a detailed description of the technique in 1933, but the name of Altemeier [5] was finally linked to this operation after his paper describing his procedure on elderly and debilitated patients was published in the Archives of Surgery in 1952.


Faecal Incontinence Rectal Prolapse Coloanal Anastomosis Perineal Approach Complete Rectal Prolapse 
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© Springer-Verlag Italia 2008

Authors and Affiliations

  • Donato F. Altomare
    • 1
  • Marcella Rinaldi
    • 1
  1. 1.Department of Emergency and Organ TransplantationUniversity of BariBariItaly

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