A Case of Idiopathic Rectal Perforation with Transanal Small Bowel Evisceration

Abstract

An 86-year-old woman with repeated rectal prolapse over the past several years was admitted to our hospital because of transanal small bowel evisceration at the time of defecation. Abdominal computed tomography (CT) showed perforation in the anterior wall of the rectum and small bowel evisceration through the rectal perforation. Rectal perforation with transanal small bowel evisceration was diagnosed, and emergency surgery was performed after the prolapsed small bowel was manually returned into the rectum. A 20-mm perforation was observed on the anterior wall of the rectum, and the small bowel was prolapsed into the rectum from the perforation. No intra-abdominal contamination and no necrotic change of the prolapsed small bowel were seen. The Hartmann's operation was performed. The patient had a good postoperative course and was discharged from the hospital on the 23rd day. Rectal perforation with transanal small bowel evisceration is a rare disease that occurs in elderly women with repeated pelvic organ prolapse, and its prognosis is considered to be relatively good. A rare case of idiopathic rectal perforation with transanal small bowel evisceration is described.