Shah Prakash, Yadav Utsav, Niroula Arpan, Rijal Amrit
Department of Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.
Department of Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.
Int J Surg Case Rep. 2025 Oct;135:111874. doi: 10.1016/j.ijscr.2025.111874. Epub 2025 Aug 28.
Transanal evisceration of small bowel through a rectal perforation is a rare surgical presentation, often associated with rectal prolapse. Its occurrence with uterine prolapse is an uncommon finding.
We report a case of a 50-year-old female with untreated third-degree uterine prolapse and COPD, who presented with transanal evisceration of approximately 100 cm of small bowel following coughing episodes. There was no history of rectal prolapse, trauma, or constipation. After ICU stabilization for sepsis, COPD exacerbation, and diabetic ketoacidosis, she underwent exploratory laparotomy, primary rectal repair, and diverting loop ileostomy. Postoperative recovery was uneventful.
Our case adds further evidence to the limited body of literature suggesting a rare complication of chronic uterine prolapse leading to spontaneous rectal perforation. The rise in intra-abdominal pressure from coughing likely triggered the event.
Uterine prolapse may independently predispose to rectal perforation and bowel evisceration. Early recognition and timely surgical intervention are key to favorable outcomes.
经直肠穿孔将小肠经肛门拖出是一种罕见的外科表现，常与直肠脱垂相关。其与子宫脱垂同时发生则较为少见。
我们报告一例50岁女性，患有未治疗的三度子宫脱垂和慢性阻塞性肺疾病（COPD），在咳嗽发作后出现经肛门拖出约100厘米小肠的情况。既往无直肠脱垂、外伤或便秘病史。在重症监护病房（ICU）对脓毒症、COPD加重和糖尿病酮症酸中毒进行稳定治疗后，她接受了剖腹探查、直肠一期修复和转流性回肠造口术。术后恢复顺利。
我们的病例为有限的文献资料增添了进一步的证据，提示慢性子宫脱垂导致自发性直肠穿孔这一罕见并发症。咳嗽引起的腹内压升高可能引发了这一事件。
子宫脱垂可能独立导致直肠穿孔和肠拖出。早期识别和及时的手术干预是取得良好预后的关键。
