Spontaneous evisceration of small bowel through the rectum in the background of rectal prolapse

Abstract

Small bowel evisceration secondary to rectal prolapse is an uncommon complication with significant morbidity and mortality if left untreated. We report a rare case of the spontaneous evisceration of the small bowel through the rectum in the background of rectal prolapse. A 73-year-old female presented to the emergency treatment unit with sudden worsening of her rectal procidentia (rectal prolapse) and pain for 3 h precipitated by straining at defecation. She had a history of complete rectal prolapse for 4 years and three uncomplicated vaginal deliveries. On examination, she was found to have evisceration of the small bowel through the anus without any evidence of strangulation. Emergency laparotomy was performed and small bowel was reduced into the abdomen with ease. She was found to have a linear tear on the anterior wall of the rectum. Primary repair of the rectal defect was carried out and a proximal defunctioning ileostomy was created. Histology was unremarkable and the recovery was uneventful. Old age, history of previous vaginal deliveries, and long-standing rectal prolapse were probable risk factors in this patient. Delay in treating this condition may result in significant morbidity and even mortality. Therefore, timely intervention is necessary.

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“…The exact pathophysiologic mechanism is not fully [2]. One case that resulted in transanal reduction and repair was reported to be successful [6]. In one series, patients who were only reduced had 100% mortality [5].…”

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

“…The exact pathophysiologic mechanism is not fully [2]. One case that resulted in transanal reduction and repair was reported to be successful [6]. In one series, patients who were only reduced had 100% mortality [5].…”

Spontaneous Evisceration of Small Bowel in Incisional Hernia

“…If the bowel is viable in emergency surgical ministration, a reduction of the contents into the abdomen followed by a primary meshplasty of the abdominal wall should be performed. Alternatively, primary closure of the abdominal wall with a delayed secondary mesh repair can be performed [ 9 ]. In the advent of features of obstruction, it is a case-based decision of the operative surgeons to decide on the viability of a bowel wall with impending features to give a trial of recovery or not.…”

“…In the advent of features of obstruction, it is a case-based decision of the operative surgeons to decide on the viability of a bowel wall with impending features to give a trial of recovery or not. In frank gangrene and bowel necrosis, resection of the involved segment is performed, followed by stoma creation or primary anastomosis depending on the intraoperative vitals, pre-operative albumin levels, bowel wall edema, and amount of intraperitoneal contamination [ 9 ]. In cases of increased intra-abdominal pressures, the hernia contents might just be given skin coverage followed by a delayed mesh repair and how the patient's operative site and general condition allow.…”