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.
A 14 years old male was admitted with the chief complaint of acute lower abdominal pain which started suddenly after he passed stools. The abdomen was tender on deep palpation in the left iliac fossa and bowel sounds were sluggish. However, on per rectal examination gut loops were felt in the anal canal and finger was stained with blood thereby making intussusception the most probable diagnosis. Basic hematological and radiological investigations were normal. Patient was taken to the operation theatre for laparotomy. A lump was felt in the left iliac fossa once the patient was anaesthetized for surgery. Peroperative findings revealed a distended and a tubular sigmoid colon (intussusception like appearance) and twisting of ileal loops around the sigmoid colon simulating ileo-sigmoid knotting. On further mobilization and gentle traction on the ileal loops gangrenous segment of ileum became evident till it finally emerged out from a longitudinal perforation (approximately15mm) in the anterior wall of rectum just above the peritoneal reflection () thereby stunning the entire surgical team. No contamination of peritoneal cavity was noticed. Gangrenous segment of ileum was resected and primary anastomosis was done. Rectal tear was closed primarily in single layer after taking the biopsy from the whole edge which revealed non specific inflammation. On repeated questioning in postoperative period patient denied any history suggestive of constipation, rectal prolapse, trauma, weight lifting, rectal instrumentation or homosexual activity; however intermittent straining at stools was present. Postoperative period remained uneventful. Barium enema and colonoscopic examination in post operative follow up period were normal.