Mrs. B. O. is a 40-year-old petty trader. She is para 1+0 with one living male child. She achieved menarche at 14 years of age. She has a regular 28 days menstrual cycle with 4 days menstrual flow, and her last menstrual period was on January 15, 2014. She presented at the gynecology clinic of University of Nigeria Teaching Hospital on January 22, 2014 with complaints of masses protruding from her vagina and anus of 24 months duration. The protrusions started 5 months after a spontaneous unsupervised delivery at home of a live male baby. The concomitant protrusions occurred spontaneously. They were usually noticed while straining, sneezing, coughing or in standing position, but often receded spontaneously while in a recumbent position. There was associated low back pain, urinary frequency, and constipation. There was no chronic cough, weight lifting, dysuria, abdominal swelling, or similar family history. About 6 months prior to the presentation, the condition became associated with weight loss and difficulty in holding her stool. The vaginal protrusion no longer receded spontaneously in recumbent position and then required manual reduction. On examination, she appeared generally well. There were no abnormal findings on the examination of the chest, abdomen, central nervous system, and the musculoskeletal system. Pelvic examination showed a protrusion of the entire uterus from the vagina. The protrusion was reducible with associated mild cystocele []. There was no demonstrable stress incontinence. The cervix was healthy looking and the os was parous. The uterus was normal sized, retroverted, and mobile. The adnexa were free. Rectal examination showed a concomitant mass (rectum) protruding from the anus []. There was associated fecal incontinence, but the rectal mucosa was normal. A diagnosis of concomitant occurrence of uterovaginal prolapse (procidentia) and rectal prolapse was made. The hemoglobin concentration, white cell count, urinalysis, culture of her midstream urine, stool analysis and culture, and abdominopelvic ultrasound showed no abnormality. In view of her parity and desire to retain her reproductive function, she and her husband were counseled for open abdominal sacrohysteropexy with synthetic mesh and rectopexy, which they consented to. Following the above investigation results which were available within 2 weeks from her first clinic visit, she was admitted into the ward for the above surgery. While in the ward, she was reviewed by the general surgeons who commenced her on a 1-day mechanical bowel preparation alongside with antibiotics bowel preparation, using the oral neomycin and metronidazole for antibiotics bowel preparation. She had an overnight fasting prior to the day of surgery and was placed on intravenous fluid (normal saline) to ensure adequate rehydration. She received intravenous ceftriaxone and metronidazole as preoperative antibiotics medication. She subsequently had a successful surgery done by a combined team of gynecologists and general surgeons. The surgical procedure briefly involved a general anesthesia/endotracheal intubation; peritoneal cavity entered via a midline sub-umbilical incision; synthetic mesh sutured to the back of the cervix with the other end sutured to a prominent part of sacral promontory (sacrohysteropexy); rectum lifted and sutures taken to secure the sides to the sacrum with a synthetic mesh that provided added reinforcement (rectopexy).\nThe postoperative period was uneventful and she is being follow-up in the gynecologic clinic. Her last clinic visit, before this report was on June 30, 2014; she had no complaint and was happy with the procedure.
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.