Abstract
A 62-year-old man underwent an abdominal transanal resection with a J-pouch anal anastomosis for lower rectal cancer and diverting loop ileostomy for postoperative vesicorectal fistula in the left lower abdomen 1 year previously. The patient was admitted to the hospital with abdominal pain and a prolapsed ileostomy which has occurred while he was playing tennis. The patient has devised a handmade device to protect the stomal pack. The prolapse was difficult to reduce and marked discoloration of the bowel wall was observed as bowel necrosis. An emergency laparotomy through a midline incision found a prolapsed double-barreled ileostomy complicated with an incarcerated intestinal loop. Intraoperative findings showed that the proximal small intestine had prolapsed at the double-barreled ileostomy. The strangulated small intestine was resected, and a new single-barreled ileostomy was constructed at the same site （left lower abdomen）. The resected specimen did not reveal the origin of the intussusceptions. Pressure from handmade device was suspected as the cause of the prolapse of the proximal side of the small intestine.
