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 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.