Spontaneous trans-anal evisceration of small bowel: a case report

Abstract

Trans-anal evisceration of small bowel is a rare surgical presentation. The first case ever reported was in 1827. The exact mechanism of how this develops remains poorly understood. A 70-year-old lady presented with multiple small bowel loops eviscerated through the anus. Abdominal exploration was done. The bowel was carefully reduced. There was a longitudinal defect on the anterior wall of the rectum at the recto-sigmoid junction and a large mesenteric defect and thrombosed mesenteric vessels compromising blood supply to part of the bowel. Resection of 50 cm of ileum, jejunostomy and a mucous fistula were performed. Several preexisting pathologies such as rectal prolapse can result in thinning out of the wall of the rectum. That combined with increased intra-abdominal pressure can explain trans-anal evisceration of the bowel. This condition is managed by surgical intervention. The operation will depend on the extent of viability, contamination and patient’s general condition.

Rare case of an 83-year-old woman with transrectal small bowel evisceration caused by spontaneous rectal perforation

“…Spontaneous rectal perforations with transanal small bowel herniation are extremely rare emergencies with a dramatic clinical presentation. Less than 100 cases have been published since the first description in the literature by Brodie in 1927 2–5. In most of these cases, small intestine is involved.…”

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

“…Based on the reviews by Wrobleski and later Morris, spontaneous small bowel evisceration per rectum occurs more frequently among elderly women, some having rectal and uterine prolapse concurrently [1] , [5] , [6] , [7] . Although the exact etiology of this phenomenon is not clearly known, chronic rectal prolapse has been linked to this pathology as a predisposing factor [3] , [8] , [9] , [10] , [11] . In some cases, however, like our case, the patients did not have any history of rectal prolapse [1] , [12] , [13] , [14] , [15] , [16] .…”

“…Although several authors reported successful outcomes without colostomy, there were no mortality in cases managed with Hartmann's procedure. Simultaneous treatment of the causative factor such as rectopexy for rectal prolapse should also be considered [1] , [3] , [11] , [13] , [20] If left untreated, this condition has 100% mortality, but with proper treatment the mortality rate is reduced significantly [2] . It is suggested that to prevent this rare condition, its predisposing factors such as rectal prolapse and uterine prolapse should be treated before the development of complications, especially in elderly patients [15] .…”

“…Trans -anal small bowel evisceration is an extremely rare condition. Since Benjamin Brodie documented the first case in 1827 [1] , to our knowledge more than 70 cases have been reported in the scientific literature [2] , [3] . We report a case of trans-anal small bowel prolapse in an otherwise healthy 25 years old woman.…”

Rectal Prolapse and Spontaneous Perforation Causing Transanal Evisceration of the Small Bowel: A Case Report. Clinical History May Predict this Condition

“…9cases were caused by transanal suction from a swimming pool drain [2,3] blunt abdominal trauma [4], 3 related to penetrating injury and 1 case in an infant caused by intense coughing [5]. In adult patients, this condition is usually caused by trauma (including iatrogenic perforation), and spontaneous perforation which etiology remains uncertain [6]. Most of the spontaneous cases have been reported in elderly patients associated with chronic rectal prolapse and an event of sudden increase of abdominal pressure [7][8][9].…”