Martínez Pérez Aleix, Torres Sánchez María Teresa, Richart Aznar Jose Manuel, Martí Martínez Eva María, Martínez-Abad Manuel
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, Spain.
Ann Coloproctol. 2014 Feb;30(1):47-9. doi: 10.3393/ac.2014.30.1.47. Epub 2014 Feb 28.
Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.
结直肠损伤导致的经直肠脏器脱出是一种罕见的病症。这种病理情况在老年患者中更为常见，通常是自发产生的。直肠脱垂是主要的诱发因素。一名81岁女性因肠袢经肛门脱出被送往医院。在采取初步复苏措施后，决定进行紧急手术。我们发现腹腔内几乎没有小肠袢；它们都已移入盆腔。复位后，发现上段直肠有一个3至4厘米的头尾向线性穿孔，并实施了哈特曼手术。我们调查得知她经常自行抠便。快速的术前处理避免了致命的结局或广泛的肠道切除。文中解释了我们将直肠自伤视为病因的原因。
