Evisceration of small bowel through spontaneous perforation of rectum: Case report and review of literature

Farda, Wais; Shaban, Mohammad Omar; Sadeq, Mohammad Salem; Mangal, H. N.; Hail, Mohammad Ibrahim; Barakzai, Shogoofa

doi:10.1016/j.ijscr.2021.106306

“…In a postmenopausal female, reduced estrogen could cause atrophy of the urogenital diaphragm and pelvic support structures due to diminished vascularity, making the structures lax and prone to prolapsing through the vaginal wall [ 2 , 5 ]. Compounding factors such as weight lifting, falling, chronic coughing, and chronic constipation could further lead to enlargement of the rent with further progression leading to an active presentation [ 2 , 4 , 5 , 14 ]. The mechanism of injury can be explained by the levels of vaginal support as specified by Delancey.…”

Section: Discussionmentioning

confidence: 99%

“…Management of the postoperative ileus by prokinetic agents helped in the course of resolution and acted as an indication of the viability of the bowels. Due to the associated rarity and complications by the delay in proper treatment, it is imperative to use a multidisciplinary approach involving obstetricians, general surgeons, and an internist team, for patients with bowel evisceration to make a complete and successful recovery [ 6 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Transvaginal Small Bowel Evisceration With Uterine Procidentia: A Report of a Rare Case

Pinto¹,

Hegde²,

Karekal³

et al. 2022

Cureus

2

0

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Spontaneous transvaginal small bowel evisceration is an extremely rare condition with a few more than 100 documented cases to date. The complications of such a rare entity revolve around its preoperative presentation as well as its operative and postoperative complications. The complications seen are intestinal incarcerations and perforations with an increased risk of post-surgical ileus and peritonitis in a timedependent fashion. In our case, a postmenopausal female presented with sudden onset bowel evisceration through a defect in the posterior vaginal apex during straining for defecation. Past medical history was significant for intermittent abdominal pain, bloating, and chronic constipation. The patient had no signs of trauma, signs of sexual assault, preceding events, or prior urinary disturbances. The patient was treated surgically with laparotomy and bowel-packing followed by Ward-Mayo's repair with added on anterior and posterior colporrhaphy, and site-specific repair. Postoperatively, following a period of prolonged ileus, the patient made a full recovery. This case report aims to provide a better understanding of the mechanism and occurrence of such an event and also intends to raise awareness of this rare presentation as an emergency condition requiring prompt surgical management.

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“…The repeated pressure to the wall results in ischemia and weakening of the wall. It is proposed that increased intraabdominal pressure from straining, vomiting, coughing, or weightlifting, can be the precipitating event that leads to perforation of the weakened wall, allowing small bowel to herniate through the defect and eviscerate through the anus [4]. Causes of spontaneous bowel perforation have been reported, such as neoplasia, colitis, diverticular disease, penetrating or blunt trauma, iatrogenic injury, chronic constipation, ulceration, suction injury, enteroptosis, forceful reduction of rectal prolapse, prolapse with chronic decubitus ulcer and pressure necrosis [1,5].…”

Section: Case Reportmentioning

confidence: 99%

Untitled

2024

Clin Med Rev Case Rep

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Transanal small bowel evisceration is a very rare presentation. However, it is associated with significant morbidity and mortality. Our case report describes an 84-year-old female with known rectal prolapse, who presented to the emergency room in sepsis with transanal small bowel evisceration after cancelation of her elective surgical repair. Due to her acutely ill presentation, she required a damage control operation, additional surgery, intensive care management, prolonged hospital stay, and a small bowel resection in addition to a colostomy. This shows the importance of timely, definitive surgical treatment for rectal prolapse, especially in healthy individuals who can tolerate surgical intervention.Surgery office after presenting to the emergency room with rectal prolapse, which was successfully reduced. The patient reported some mild constipation requiring stool softeners and had never had a colonoscopy. On the exam, she had a reduction in anal tone, and rectal prolapse was noted with straining. After discussion with the patient and her family, the decision was made to proceed with an open rectopexy and colonoscopy. About one month after her office visit, her family canceled her scheduled surgery, reporting that the patient's symptoms had resolved.Two months later, the patient presented to the hospital with small bowel herniation through her anus with compromised blood supply (Figure 1), which the

show abstract

“…The repeated pressure to the wall results in ischemia and weakening of the wall. It is proposed that increased intraabdominal pressure from straining, vomiting, coughing, or weightlifting, can be the precipitating event that leads to perforation of the weakened wall, allowing small bowel to herniate through the defect and eviscerate through the anus [4]. Causes of spontaneous bowel perforation have been reported, such as neoplasia, colitis, diverticular disease, penetrating or blunt trauma, iatrogenic injury, chronic constipation, ulceration, suction injury, enteroptosis, forceful reduction of rectal prolapse, prolapse with chronic decubitus ulcer and pressure necrosis [1,5].…”

Section: Case Reportmentioning

confidence: 99%

A Rare, Severe Complication of Delayed Surgical Treatment for Rectal Prolapse

Rachel,

Amanda

2024

Clin Med Rev Case Rep

0

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Transanal small bowel evisceration is a very rare presentation. However, it is associated with significant morbidity and mortality. Our case report describes an 84-year-old female with known rectal prolapse, who presented to the emergency room in sepsis with transanal small bowel evisceration after cancelation of her elective surgical repair. Due to her acutely ill presentation, she required a damage control operation, additional surgery, intensive care management, prolonged hospital stay, and a small bowel resection in addition to a colostomy. This shows the importance of timely, definitive surgical treatment for rectal prolapse, especially in healthy individuals who can tolerate surgical intervention.Surgery office after presenting to the emergency room with rectal prolapse, which was successfully reduced. The patient reported some mild constipation requiring stool softeners and had never had a colonoscopy. On the exam, she had a reduction in anal tone, and rectal prolapse was noted with straining. After discussion with the patient and her family, the decision was made to proceed with an open rectopexy and colonoscopy. About one month after her office visit, her family canceled her scheduled surgery, reporting that the patient's symptoms had resolved.Two months later, the patient presented to the hospital with small bowel herniation through her anus with compromised blood supply (Figure 1), which the

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Evisceration of small bowel through spontaneous perforation of rectum: Case report and review of literature

Cited by 4 publications

References 16 publications

Spontaneous Transvaginal Small Bowel Evisceration With Uterine Procidentia: A Report of a Rare Case

Spontaneous Transvaginal Small Bowel Evisceration With Uterine Procidentia: A Report of a Rare Case

Untitled

A Rare, Severe Complication of Delayed Surgical Treatment for Rectal Prolapse

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