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.
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.