Sepsis after the Altemeier procedure: A case report

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.