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 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.