Spontaneous rupture of the distal colon with evisceration of small intestine through the anus: report of two cases and review of the literature

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

INTRODUCTION

Small bowel evisceration through spontaneous perforation of the rectum is an extremely rare condition in which the small bowel herniates mostly through a defect in the anterior rectal wall.

CASE PRESENTATION

We present the case of a 25-year-old otherwise healthy lady who denied any history of rectal prolapse or trauma.

DISCUSSION

Small bowel evisceration through rectum is a rare surgical emergency with a mortality rate as high as 42.3%. Apart from trauma, chronic constipation, rectal prolapse, presence of a deep Douglas pouch and a sliding hernia formed by the cul-de-sac have also been described as etiological factors.

CONCLUSION

It is extremely difficult to find out the actual cause of "spontaneous" small bowel evisceration, especially in young adults.

Transanal evisceration of small bowel in two patients with chronic rectal prolapse: case presentation and literature review

There are fewer than 100 documented cases of transanal small bowel evisceration in the literature. We report two cases of this rare surgical emergency in an 84-year old man and a 79-year old woman. Both patients required urgent laparotomy, resection of ischaemic bowel and transabdominal resection of the rectal defect with colostomy. Postoperative recovery was uneventful. Rare imaging and clinical photography are shared to highlight the extreme nature of this condition. We identified 38 relevant cases of reported bowel evisceration through our literature review. Most patients were elderly women with untreated rectal prolapse. Gynaecological comorbidity was another risk factor. The aetiological mechanism is suspected to stem from chronic ischaemic insult to the rectal wall, resulting in thinning and subsequent perforation. Surgical management may consist of primary suture repair of the rectal tear, or a Hartmann's procedure. Timely intervention is essential to minimise patient morbidity and mortality.

Transanal evisceration of the small bowel a rare complication of rectal prolapse

•

A 78-year-old female with history of chronic rectal prolapse who presented in our emergency department with evisceration of small intestinal loops through the anus.

•

In surgery after complete reduction of the eviscerated bowel into the peritoneal cavity, almost 20 cm of the terminal ileum up to the ileocecal valve were necrotic and therefore a right hemicolectomy with primary anastomosis was performed.

•

Additionally a 2 cm craniocaudally tear was revealed in the antimesenteric border of the upper rectum and a Hartman procedure was also performed.

•

The patient was discharged after 10 days.

Introduction

Transanal evisceration of small bowel is an extremely rare surgical emergency. Of the nearly 70 cases reported in the literature, rectal prolapse is the predisposing factor that has been most frequently related to this pathology.

Presentation of case

We report a 78-year-old female with history of chronic rectal prolapse who presented in our emergency department with evisceration of small intestinal loops through the anus. In surgery after complete reduction of the eviscerated bowel into the peritoneal cavity, almost 20 cm of the terminal ileum up to the ileocecal valve were necrotic and therefore a right hemicolectomy with primary anastomosis was performed. Additionally a 2 cm craniocaudally tear was revealed in the antimesenteric border of the upper rectum and a Hartman procedure was also performed. The patient was discharged after 10 days.

Discussion

Early recognition and timely surgical intervention offers the best prognosis, avoiding a fatal conclusion or an extensive intestinal resection.

Transanal evisceration of small bowel-a rare surgical emergency

Transanal evisceration of small bowel is an extremely rare surgical emergency. This is the condition in which the small bowel herniates through breach in the anterior rectal wall and seen eviscerating through the anal canal. It is challenging for a surgeon to deal and manage such a case during emergency, especially if he hasn't dealt with such condition earlier. The present case reported is of 68 year old lady referred to an institution with history of transanal herniation of small bowel for three days duration, following manual reduction of chronic rectal prolapse. The case report illustrates aetiology, management & factors influencing the outcome of this rare emergency have been discussed.

Small bowel evisceration through the anus in rectal prolapse in an Indian male patient

Evisceration of small intestine through anus is a rare presentation in emergency. We reported a case with long history of recurrent complete rectal prolapse presenting in emergency as small bowel protruding out through anal orifice. The small bowel herniated out from a spontaneous perforation in rectosigmoid. After resuscitation, emergency exploratory laparotomy was carried out and small bowel was reposited in the peritoneal cavity through the site of perforation by pulling and pushing maneuvere and the perforated segment of rectosigmoid was exteriorised as double barrel colostomy.

Small bowel evisceration through the anus--report of a case and review of literature

An 84-year-old lady with a history of chronic recurrent rectal prolapse, presented to accident and emergency with a significant portion of small bowel and mesentery protruding out of her anus. The small bowel was not contained within peritoneum, nor was this a pararectal herniation. On examination of the rectum, a longitudinal tear was found in the anterior rectal wall, through which the small bowel had prolapsed. Hours after reducing the small bowel back into the anus, it prolapsed a second time. Due to multiple co-morbidities, this patient was not fit for surgery. The defect was temporarily repaired on the ward and the patient treated with aggressive antibiotic therapy. The patient continued to deteriorate, became septic, acidotic, hypotensive and died a day later.

Spontaneous perforation of rectum with evisceration of small bowel simulating intussusception

CONTEXT

Spontaneous perforation of rectum is a rare event; however evisceration of the small bowel through the perforated site without predisposing factors is extremely rare, complex and worth reporting.

CASE REPORT

A 14 years old presented to us apparently as a case of intussception. The operative findings revealed it to be a case of spontaneous perforation of rectum with evisceration of the small bowel through the perforation.

CONCLUSION

Sudden increase in the intra-abdominal pressure leads to the perforation in the chronically deranged rectal wall and pushes the small bowel loops into the pelvis and through the perforated rectum to appear transanally.

Prolapse of the rectum associated with spontaneous rupture of the distal colon and evisceration of the small intestine through the anus in an infant

Prolapse of rectum of varying degrees is a well-known entity in children. Spontaneous rupture of the rectum along with massive ileal evisceration because of increased intraabdominal pressure is a rare complication of rectal prolapse in the adults. Rectal prolapse in children is usually a benign condition. Known complications of the rectal prolapse in children include recurrent mucosal ulceration, bleeding, and proctitis. Spontaneous rupture of the rectum with or without ileal evisceration has not been previously reported in infants.

Transanal Small Bowel Evisceration: An Unusual Presentation of Rectal Impalement

Traumatic transanal small bowel evisceration is a rare condition usually associated with suction injuries or blunt abdominal trauma. We report the first case of intestinal evisceration through the anus caused by penetrating trauma (rectal impalement). Additionally, we performed a literature review of all English language articles since 1970 concerned with traumatic transanal small bowel evisceration. Mechanisms of injury and the surgical management are discussed.

Thiersch repair of a spontaneous rupture of rectal prolapse with evisceration of small bowel through anus - a case report

Spontaneous rupture of colon or rectum is a rare event. Protrusion of several loops of small bowel through the anal orifice is a bizarre condition which has only rarely been reported in the literature. We report the first case where Thiersch repair was used to manage spontaneous perforation of rectal prolapse and provided a successful outcome.

Rectal prolapse

INTRODUCTION

Rectal prolapse, or procidentia, is defined as a protrusion of the rectum beyond the anus. It commonly occurs at the extremes of age. Rectal prolapse frequently coexists with other pelvic floor disorders, and patients have symptoms associated with combined rectal and genital prolapse. Few patients, a lack of randomized trials and difficulties in the interpretation of studies of anorectal physiology have made the understanding of this disorder difficult.

METHODS OF TREATMENT

Surgical management is aimed at restoring physiology by correcting the prolapse and improving continence and constipation, whereas in patients with concurrent genital and rectal prolapse, an interdisciplinary surgical approach is required. Operation should be reserved for those patients in whom medical treatment has failed, and it may be expected to relieve symptoms. Numerous surgical procedures have been suggested to treat rectal prolapse. They are generally classified as abdominal or perineal according to the route of access. However, the controversy as to which operation is appropriate cannot be answered definitively, as the extent of a standardized diagnostic assessment and the types of surgical procedures have not been identified in published series.

LITERATURE REVIEW

This review encompasses rectal prolapse, including aetiology, symptoms and treatment. The English-language literature about rectal prolapse was identified using Medline, and additional cited works not detected in the initial search were obtained. Articles reporting on prospective and retrospective comparisons and case reports were included.

Successful Laparoscopic Repair of Spontaneous Rectosigmoid Rupture With an Acute Transanal Small Bowel Evisceration

This report describes the first successful laparoscopic approach for transanal small bowel evisceration secondary to spontaneous rectal rupture, indeed a very rare event. A brief description of our technique and the pathophysiologic features of this condition are given.

Incarcerated rectal prolapse--rupture and ileal evisceration after failed reduction: report of a case

We report a case of incarcerated rectal prolapse that could not be reduced after using the previously described application of ordinary table sugar. Gentle pressure caused the prolapsed rectum to perforate, and the small bowel herniated through the tear. This is only the second case reported in the literature of an ileal herniation through a perforated rectum after an attempted reduction of an incarcerated prolapse. It is the only reported case occurring after sugar application and the 42nd case of ileal herniation through the rectum from all causes.

Acute transanal ileal evisceration

This is the 31st report of spontaneous transanal evisceration of small bowel. This case is unique because a rectal prolapse had been repaired previously and at the time of evisceration, there was no evidence of recurrence. Inherent or acquired weakness of the anterior rectal wall combined with a sudden increase in intra-abdominal pressure appears to precipitate this rare phenomenon. Attention to basic surgical tenets applies in the management of this condition.

Intestinal evisceration resulting from a motor vehicle accident

Presented is the case of a motor vehicle accident (MVA) victim with hypotension and evisceration of small intestine. Vigorous resuscitation in the emergency department was required, after which a portion of small bowel was resected at laparotomy. Evisceration secondary to trauma in an MVA is a rare injury. Significant blood loss occurs. Although abdominal sepsis did not occur in our case, this is a complication for which the patient must be monitored closely.

Spontaneous rupture of the rectosigmoid with small-bowel evisceration through the anus. Report of a case and review of the literature

A patient with spontaneous rupture of the rectum and evisceration of small bowel through the anus is presented. To the authors' knowledge, this paper represents the third reported case of this type of spontaneous rectal rupture. A discussion of the pathogenesis and treatment of this rather unique complication is presented. It is suggested that rectal or rectosigmoid rupture be considered a rare complication of rectal prolapse.

Rectosigmoid perforation and intestinal evisceration from transanal suction

Transanal suction injuries were sustained in 1981 by five children when they sat upon uncovered swimming area drain sites. Tears of the rectosigmoid areas occurred in each with associated evisceration and loss of substantial amounts of small intestine because of mesenteric separation. These cases are reviewed.

Traumatic evisceration of intestinal loops through the anus

A case of traumatic evisceration of intestinal loops through the anus in a young child is presented. This unusual injury took place in a swimming pool and was brought about when a negative pressure applied to the child's perineum by the suction pump created a pressure differential of sufficient force to cause the injury. Surgical management of the case is discussed.