A Case of Idiopathic Rectal Perforation with Small Bowel Evisceration and Rupture Through the Anus

Abstract

An 81-year-old woman had undergone transanal surgery for rectal prolapse at another hospital five years earlier. She experienced intestinal prolapse during defecation, unusual bleeding, and gradual onset of abdominal pain and vomiting. She visited our hospital Emergency Department with her family. An emergency operation was performed because the small intestine was found to have prolapsed through the anus and ruptured at two points. The prolapsed small intestine was resected, and the oral and anal stumps were returned to the prolapsed rectal lumen. The anus was narrow, and the operation in another hospital seemed to have been the Thiersch method. The rectal prolapse was reduced by making an incision in the perineal region and cutting the sutured anal ring. Laparotomy showed a perforation 3 cm in diameter in the anterior wall of the Rs rectum, and the small intestine was invaded. A functional end-to-end anastomosis was made. The rectum was resected, and an end stoma was created at the oral stump. After the operation, 2 units of RBCs were transfused for anemia. Computed tomography guided drainage was performed for the pelvic abscess, and the patient was discharged on day 40.