582 A case of small bowel prolapsing through the anus

Abstract

Abstract Introduction A 46 year old man presented to the accident and emergency department in severe pain and with bowel prolapsing through the anus. This occurred when he was straining on the toilet. On closer examination it was noted that the bowel coming through the anus was small bowel, and starting to become ischaemic. On closer questioning he admitted to inserting a plastic object in his rectum about half an hour prior to straining. He was therefore taken straight to theatre for a laparotomy. Intra operative findings A midline laparotomy was performed. The small bowel was reduced back into the abdominal cavity and packed away in a warm swab. The rectum was examined and a 4cm hole was seen in the upper rectum. There was no contamination with faeces or pus, therefore it was sutured with PDS 2-0. By this time the small bowel was looking less dusky however the mesentery was extremely bruised. As there was improvement a decision was made to close and re-look in 24 hours. He was kept intubated overnight in ITU and was taken back to theatre the next day. At this point the small bowel appeared pink and healthy, therefore no resection was performed however a loop colostomy was fashioned to protect the upper rectal perforation repair. Discussion This is a rare condition with very few cases described in the literature. Management is highly dependent on clinical presentation. Imaging was not felt to be helpful in this case due to obviously comprised small bowel therefore he was operated on immediately.