Small bowel evisceration through the anus - report of a case and review of literature

Berwin, James T; Ho, Tsung-Ying; D'Souza, R

doi:10.1136/bcr.12.2011.5316

Cited by 17 publications

(17 citation statements)

References 9 publications

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“…The review of literature by Morris et al [17] revealed 53 cases of evisceration of the small bowel on rectal prolapse since the first case described by Brodie and of these 53 cases, 22 (41.5%) cases had died. Our patient died in the preoperative phase after a short delay after admission, as reported by Berwin JT et al [16].…”

Section: Therapeutic Aspects and Prognosissupporting

confidence: 59%

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Strangulated Transanal Evisceration of Small Bowel Complicating Rectal Prolapse of the Child: An Observation of the University Hospital Center of Parakou, Benin

Hodonou¹,

Tamou-Sambo²,

Gandoho³

et al. 2018

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Transanal intestinal evisceration is an extremely rare and dramatic digestive surgical emergency. The cases reported in the literature are few and concern much more elderly patients. We report the case of a 3-year-old boy admitted in very general poor condition to the emergency department, late for transanal evisceration complicating rectal prolapse that the parents tried to reduce. The fatal outcome of this case is probably related to strangulation and delay in consultation. We learn from this that parents should avoid inopportune prolapse reduction and early consultation.

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Section: Therapeutic Aspects and Prognosissupporting

confidence: 59%

“…But most of the time this attempt at reduction without laparotomy proves to be fruitless [16] as mentioned by several case studies [3] [11]. We did not attempt it in our patient because of the strangulation and inflammation of the loop.…”

Section: Therapeutic Aspects and Prognosismentioning

confidence: 95%

Strangulated Transanal Evisceration of Small Bowel Complicating Rectal Prolapse of the Child: An Observation of the University Hospital Center of Parakou, Benin

Hodonou¹,

Tamou-Sambo²,

Gandoho³

et al. 2018

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“…Most acceptable pathophysiology seems to be a rectal prolapse in the form of a ‘sliding hernia’ in the pouch of Douglas and the contained viscera form the hernia sac 2 3. The hernia sac invaginate the anterior wall of the rectum into the rectal lumen and it usually happens at the antimesenteric border 4 5. This repeated insult to the wall results in ischaemia at the local site along with weakening.…”

Section: Discussionmentioning

confidence: 99%

Small bowel evisceration through the anus in rectal prolapse in an Indian male patient

2013

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Evisceration of small intestine through anus is a rare presentation in emergency. We reported a case with long history of recurrent complete rectal prolapse presenting in emergency as small bowel protruding out through anal orifice. The small bowel herniated out from a spontaneous perforation in rectosigmoid. After resuscitation, emergency exploratory laparotomy was carried out and small bowel was reposited in the peritoneal cavity through the site of perforation by pulling and pushing maneuvere and the perforated segment of rectosigmoid was exteriorised as double barrel colostomy.

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“…However attempt to reduce the bowel through the anal canal without laparotomy is, most of the time, unsuccessful and results in higher mortality [10].…”

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confidence: 99%

Transanal Evisceration of Small Bowel-A Rare Surgical Emergency

Narayanaswamy¹

2014

JCDR

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A 68-year-old lady was referred to our emergency department, with evisceration of small bowel through anal canal following manual reduction of prolapsed rectum, three days ago. On careful and thorough examination, she was found to be hemodynamically stable. Abdomen was soft and did not show any features suggestive of peritonitis. About three feet of the small bowel with its mesentery was eviscerating through the anal canal which was congested, oedematous and had multiple serosal tears [Table/ Fig-1].In emergency department, the eviscerated bowel was washed copiously with warm saline and covered with moist towels. Broad spectrum antibiotics were given and IV fluids were started. Relevant preoperative work up was done and patient was posted for emergency laparotomy.A lower midline laparotomy was performed, and the eviscerated bowel was gently reduced into the peritoneal cavity with simultaneous support and guidance through the anal canal. After complete reduction of the eviscerated bowel into the peritoneal cavity, a 2x3 cms perforation was noted in the anterior wall of the middle third rectum [Table/ Fig-2]. The margin of perforation was freshened and closed with interrupted polyglactin sutures. A sigmoid loop colostomy was also performed. In view of dilated and congested small bowel with multiple serosal tears, a laparostomy was performed to observe for the integrity and viability of bowel in post-operative period.Immediate post-operative period was uneventful. After 48 hours, saline wash was given through the laparostoma, under epidural analgesia. The bowel appeared normal. However on the fourth post-operative day patient developed breathlessness, bradycardia, hypotension and desaturation with respiratory acidosis. On evaluation she was diagnosed to have acute myocardial infarction with elevated troponin-T levels. The patient was supported with ventilator and inotropes with immediate treatment of the acute myocardial infarction. Despite our prompt response and best supportive care, the patient did not recover from the cardiac insult and succumbed on the twelfth post operative day with multiple organ dysfunction. DIsCUssIoNTransanal evisceration of bowel is a rare complication of chronic prolapse of rectum. This surgical emergency occurs due to herniation of bowel through the breech in the rectal wall. This condition was first described by Brodie in 1827, since then very few cases have been reported [1]. Wrobleski DE, Dailey TH presumed that mainly two factors predispose these patients for this unusual complication. More than 75% of these cases were associated with chronic prolapse of rectum and an event of sudden increase in intra-abdominal pressure [2][3][4]. Broden B, Snellman B with cine-radiographic studies tried to correlate prolapse rectum with perforation. The primary mechanism of rectal prolapse is a sliding hernia, in which the pouch of Douglas and contained viscera form the sac. The hernial sac invaginates the anterior wall of rectum into the rectal lumen resulting in ischemia and the weakening, makin...

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Small bowel evisceration through the anus - report of a case and review of literature

Cited by 17 publications

References 9 publications

Strangulated Transanal Evisceration of Small Bowel Complicating Rectal Prolapse of the Child: An Observation of the University Hospital Center of Parakou, Benin

Strangulated Transanal Evisceration of Small Bowel Complicating Rectal Prolapse of the Child: An Observation of the University Hospital Center of Parakou, Benin

Small bowel evisceration through the anus in rectal prolapse in an Indian male patient

Transanal Evisceration of Small Bowel-A Rare Surgical Emergency

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