A 73-year-old otherwise healthy female presented to the emergency treatment unit with sudden worsening of rectal procidentia (rectal prolapse) and pain for 3 h after straining at defecation. She had a history of reducible complete rectal prolapse for 4 years, for which she did not seek treatment. She had three uncomplicated vaginal deliveries in the past. On examination, she was found to have evisceration of the small bowel through the anus rather than a rectal prolapse, without any macroscopic evidence of strangulation (). There was associated uterovaginal prolapse and perineal descent suggestive of pelvic floor dysfunction. She was hemodynamically stable with normal blood pressure and heart rate. Her biochemical investigations including serum lactate were all normal. Emergency laparotomy was performed and the small bowel was reduced into the abdomen with ease. She was found to have a linear tear, 6 cm from the anal verge on the anterior wall of the middle part of the rectum without any macroscopic evidence of ischemia or neoplasm (). The reduced small bowel was normal in appearance with good peristalsis. Primary repair of the rectal defect was carried out after obtaining a biopsy from the rectal tear and a proximal defunctioning ileostomy was created. Histological examination of the rectal biopsy was unremarkable. She was managed in the intensive care unit for 2 days post-operatively and had an uneventful recovery. The patient was discharged on the fifth post-operative day.
A 73-year-old woman who had had a 3-year history of concomitant rectal and vaginal prolapse came to the hospital with the chief complaint of a huge part of her bowels suddenly coming out of her anus. There was a pinkish bowel coming out 7 h before. By coughing, the bowel outside became longer and longer over time until it reached the size of 200 cm. It occurred to the patient who had fallen down on the floor in a sitting position. There was no severe abdominal pain and no history of repeated episodes of colicky pain, as usually happens in intussusception case [].\nOn physical examination, an evisceration of small bowel was seen and so was vaginal prolapse (Fig. ). The patient had a weak general state, no bowel sounds, no muscular rigidity, and no general peritonitis. The length of the bowel that went out of the anus was around 200 cm and it was not necrotic. Surgery was performed through midline incision, and the surgeon found the small bowel entering a tear defect on the sigmoid wall. Around 10 mL of peritoneal fluid mixed with fecal materials was found in the surrounding ruptured area. A redundant sigmoid was also found and the eviscerated ileum was still viable and was gently pulled out of the defect on the sigmoid wall until all the eviscerated ileum was repositioned into the abdominal cavity. The rupture of the sigmoid wall was stitched using primary suture and brought out as a loop sigmoidostomy for safety. The patient was allowed to go home on the 5th day and after 30 days the patient had recovered uneventfully.