270 Spontaneous Trans-anal Evisceration of Small bowel: A Case Report

Abstract

Abstract Introduction Trans-anal evisceration of small bowel is a very rare surgical presentation. The first case ever reported was in 1827. The exact mechanism of how this develops remains poorly understood. Majority of the cases recorded there was a perforation in the anterior wall of the rectum. Case Report: A 70-year-old female patient with a history of multiple strokes, presented with multiple small bowel loops eviscerated through the anus. The bowel was covered with warm saline soaked packs and the patient was transferred to theater. Abdominal exploration through was done. The bowel was carefully reduced. There was a longitudinal defect on the anterior wall of the rectum at the recto-sigmoid junction. There was also a large mesenteric defect and thrombosed mesenteric vessels compromising blood supply to part of the bowel, so resection of 50 cm of ileum, jejunostomy and a mucous fistula were performed. Conclusions Several pre-existing pathologies, like diverticular disease or rectal prolapse can result in thinning out of the wall of the rectum. That combined with increased intra-abdominal pressure can explain trans-anal evisceration of the bowel. This condition is typically managed by surgical intervention. The operation will depend on the extent of viability, contamination, and patient’s general condition.