Department of General Surgery, Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Br J Hosp Med (Lond). 2024 Jul 30;85(7):1-3. doi: 10.12968/hmed.2024.0043. Epub 2024 Jul 16.
A 46-year-old man presented with a small bowel prolapsing through the anus after straining on the toilet, which was starting to become ischaemic. He admitted to inserting a plastic object in his rectum about half an hour before straining. The bowel was kept moist by placing an intravenous drip line with saline dripping onto a wet swab. In theatre, the bowel was found to be prolapsing through a hole in the upper rectum and out through the anus. It was reduced back into the abdominal cavity through the same perforation, which was 4 cm long, without needing to extend it. This was sutured with polydioxanone (PDS) 2-0 as there was no contamination with faeces or pus. Due to improvement in the appearance of a small bowel and an extremely bruised mesentery, a re-look was planned in 24 hours. At the re-look the small bowel appeared healthy, therefore no resection was performed. However, a loop colostomy was fashioned to protect the upper rectal perforation repair. This shows that resection is not always required in such cases.
一位 46 岁男性在厕所用力排便时出现小肠脱垂至肛门，已经开始出现缺血症状。他承认在用力排便前大约半小时将一个塑料物体插入直肠。为了保持肠的湿润，将静脉滴注线与生理盐水滴到湿棉签上。在手术室，发现肠从直肠上部的一个孔中脱垂并通过肛门脱出。通过相同的 4 厘米长的穿孔将其还纳入腹腔，无需扩大穿孔。用聚二氧杂环己酮（PDS）2-0 缝合穿孔，因为没有粪便或脓液污染。由于小肠外观和极度瘀伤的肠系膜有所改善，计划在 24 小时后再次检查。再次检查时，小肠看起来健康，因此未进行切除。然而，进行了回肠造口术以保护直肠上部穿孔的修复。这表明在这种情况下并不总是需要进行切除。
