Post-Operative Bleeding After Altemeier Procedure
A small amount of bleeding from the anus after an Altemeier procedure (perineal approach) is normal and expected during the early post-operative period. 1 This is a common occurrence following this type of rectal surgery.
Understanding the Altemeier Procedure
The Altemeier procedure (perineal proctosigmoidectomy) is a surgical technique used to treat full-thickness rectal prolapse. It involves:
- Resection of the prolapsed rectum and part of the sigmoid colon
- Creation of a colorectal or coloanal anastomosis
- Often performed in elderly or medically unfit patients due to lower operative morbidity compared to abdominal approaches 1
Normal Post-Operative Bleeding
After an Altemeier procedure, patients may experience:
- Small amounts of bright red blood from the anus
- Bleeding that may be noticed on toilet paper or in the toilet bowl
- Occasional spotting during the first 1-2 weeks post-procedure
This bleeding is typically due to:
- Healing of the surgical anastomosis
- Minor trauma to the rectal mucosa
- Normal inflammatory response at the surgical site
When to Be Concerned
While some bleeding is normal, certain bleeding patterns warrant medical attention:
- Heavy or continuous bleeding
- Large blood clots
- Bleeding associated with severe pain
- Dark blood mixed within stool (suggesting a more proximal source) 1
- Bleeding accompanied by fever, severe pain, or signs of infection
- Bleeding that persists beyond 2 weeks post-procedure
Complications of Altemeier Procedure
The Altemeier procedure has a relatively low complication rate. Studies report:
- Overall complication rate of approximately 9.6% 2
- Specific bleeding complications include:
- Anastomotic bleeding (reported in some cases) 2
- Wall portion dehiscence of anastomosis (rare)
- Anastomotic stenosis (rare)
Post-Operative Care
To manage normal post-operative bleeding:
- Maintain good perianal hygiene
- Avoid straining during bowel movements
- Use soft toilet paper or wet wipes
- Take prescribed pain medications and stool softeners as directed
- Follow activity restrictions as recommended by your surgeon
Follow-Up Recommendations
Regular follow-up with your surgeon is important to:
- Monitor healing of the surgical site
- Assess for any signs of recurrence (recurrence rates range from 6.4% to 37.9% depending on follow-up duration) 3, 4
- Evaluate improvement in symptoms and quality of life
Conclusion
Small amounts of bleeding after an Altemeier procedure are normal and expected. However, heavy, persistent, or painful bleeding should prompt immediate medical attention to rule out anastomotic complications or other issues requiring intervention.