Abstract
A 66-year-old man presented to the emergency clinic in our hospital for bloody discharge and prolapse of unidentified chord-like soft tissue from the anus following a bowel movement. Upon arrival at our hospital, shock signs were positive. The surface of the object protruding from the anus included fat, suggestive of a part of intestinal serosa. An abdominal CT scan indicated perihepatic fluid, intramesenteric extravasation of enhancement material and intussusception of the sigmoid colon into the rectal lumen without free intra-abdominal air. An emergency surgery was performed due to hemorrhagic shock and sigmoid colon prolapse with rectal perforation. During the operation, we observed a large amount of bloody ascites, mesenteric shear of the sigmoid colon with active bleeding and a tear through all layers of the anterior wall of rectum on the peritoneal reflex measuring 5 cm in length. We performed simple closure of the rectal perforation and sigmoid colostomy due to concerns of leakage under shock condition. The postoperative course was uneventful, and the patient was discharged on day 17 of hospital stay. Rectal perforation with intestinal tract evisceration through the anus has usually good prognoses due to minimum intraperitoneal contamination and early detection. However, in cases of rectal prolapse of the colon without perineal looseness, such as in this case, patients might suffer hemorrhagic shock due to mesenteric shearing.
