A 62-year-old obese female presented with spontaneous rupture of incisional hernia for 4 hours duration. She had a history of curative total abdominal hysterectomy and bilateral oophorectomy for stage 1 endometrial adenocarcinoma 3 years ago. She was also treated with adjuvant chemoradiation. Subsequently, she developed a surgical site infection and with breakdown of skin and subcutaneous tissues and was treated with repeated wound debridement and secondary suturing. She did not have diabetes mellitus or other long-standing medical comorbidities. She had noticed a bulge in the lower abdomen which was progressively enlarging in size over a period of 7 months and did not seek treatment.\nOn admission, she did not have fever or features of intestinal obstruction. She was haemodynamically stable. Her abdomen was pendulous with a large incisional hernia over the Pfannenstiel incision. A loop of grossly congested and oedematous small bowel was seen eviscerating through a small defect in the skin suggestive of early strangulation ().\nHer blood investigations including full blood count, serum electrolytes, renal functions, and clotting profile were normal. She was resuscitated and planned for emergency surgery.\nAs the first step during surgery, the strangulation was released by enlarging the skin defect which was 3 cm in diameter (). Fortunately, the bowel was viable without any evidence of gangrene. Thereafter, an elliptical incision was made over the incisional hernia incorporating the defect. A large (10 cm in diameter) abdominal wall defect was identified with extensive adhesions. Careful adhesiolysis was performed and the bowel was reduced into the peritoneal cavity. The defect was closed and an on lay mesh repair was performed. She had an uneventful recovery and was discharged on the 5th postoperative day. At one month following surgery, she had complete wound healing and was able to perform her normal day-to-day activities.
A 70-year-old, bed-bound female patient with a history of multiple strokes, presented to A + E with multiple loops of small bowel, eviscerated through the anus (). When asked, the family explained that the patient was chronically constipated and was on regular laxatives. She did not have any recent history of trauma. Her daughter had explained that she has been suffering from rectal prolapse which she could normally reduce with ease. However, this time what was prolapsing ‘from her back passage’ looked different, so she rushed her to the hospital.\nThe patient was hemodynamically stable. When examined, there was an associated uterine prolapse. The bowel loops were covered with warm saline soaked packs and the patient was immediately transferred to theater.\nAbdominal exploration through an infra-umbilical incision was done; the bowel loops were carefully reduced through the anal canal. It appeared that there was a longitudinal defect on the anterior wall of the rectum at the recto-sigmoid junction. There was also a large mesenteric defect, possibly ensued from prolonged traction, and thrombosed mesenteric vessels compromising blood supply to part of the bowel, so resection of 50 cm of ileum with a jejunostomy and a mucous fistula were performed. The postoperative recovery was uneventful and the patient was discharged 16 days after surgery.