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 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.