Basnayake Oshan, Jayarajah Umesh, Wijerathne Am Thilak
Faculty of Medicine, University of Colombo, Sri Lanka.
Department of Surgery, District General Hospital, Kegalle, Sri Lanka.
SAGE Open Med Case Rep. 2021 Apr 27;9:2050313X211011809. doi: 10.1177/2050313X211011809. eCollection 2021.
Small bowel evisceration secondary to rectal prolapse is an uncommon complication with significant morbidity and mortality if left untreated. We report a rare case of the spontaneous evisceration of the small bowel through the rectum in the background of rectal prolapse. A 73-year-old female presented to the emergency treatment unit with sudden worsening of her rectal procidentia (rectal prolapse) and pain for 3 h precipitated by straining at defecation. She had a history of complete rectal prolapse for 4 years and three uncomplicated vaginal deliveries. On examination, she was found to have evisceration of the small bowel through the anus without any evidence of strangulation. Emergency laparotomy was performed and small bowel was reduced into the abdomen with ease. She was found to have a linear tear on the anterior wall of the rectum. Primary repair of the rectal defect was carried out and a proximal defunctioning ileostomy was created. Histology was unremarkable and the recovery was uneventful. Old age, history of previous vaginal deliveries, and long-standing rectal prolapse were probable risk factors in this patient. Delay in treating this condition may result in significant morbidity and even mortality. Therefore, timely intervention is necessary.
直肠脱垂继发小肠脱垂是一种罕见的并发症，如果不治疗，会导致严重的发病率和死亡率。我们报告一例罕见的在直肠脱垂背景下小肠经直肠自发脱垂的病例。一名73岁女性因排便时用力导致直肠脱垂（直肠脱出）突然加重并伴有3小时疼痛，就诊于急诊治疗单元。她有4年完全性直肠脱垂病史，曾顺产3次。检查发现，小肠经肛门脱出，无绞窄迹象。急诊行剖腹探查术，小肠顺利回纳至腹腔。发现直肠前壁有一纵行撕裂伤。对直肠缺损进行一期修复，并做近端造瘘性回肠造口术。组织学检查无异常，恢复过程顺利。高龄、既往顺产史和长期直肠脱垂可能是该患者的危险因素。延误治疗可能导致严重的发病率甚至死亡率。因此，及时干预很有必要。
