A Case of Mucosal Prolapse Performed by Delorme Procedure after Laparoscopic Intersphincteric Resection

Abstract

We performed laparoscopically intersphincteric resection (ISR) with lateral lymph node dissection, and created a diverting loop ileostoma following preoperative chemoradiotherapy for a 36-year-old man with lower rectal cancer. In the surgery the internal anal sphincter muscle was completely resected at the anal intersphincteric groove. Totally resection of the internal anal sphincter muscle caused the patient eversion of the anal skin and anal canal mucosa. On enema examination, contrast medium leaked out of the anus. We feared of anal dysfunction following ISR. We followed the patient for one year, but, there had been no improvement in mucosal prolapse. Finally, the Delorme procedure was performed for severe mucosal prolapse occurred after ISR. There was no post-operative complication after surgery. Leakage of contrast medium out of the anus was not found after surgery. Therefore, we reversed the diverting loop ileostoma. The patient did not complain about incontinence, wearing a pad once a day. His score using the Wexner incontinence score was 4.