Abstract
We present an unusual clinical manifestation of a rectal rupture discussing two cases of female patients hospitalized and operated on urgently. The extraordinary presentations during physical examination, which eventually provided a solid indication for immediate operation included sigmoid colon prolapse in one case and evisceration of small intestine through the anus in the other. In both patients, Hartmann procedure was successfully performed resulting in relatively fast recovery despite an elderly age and hospital discharge on the 10th postoperative day. Although sigmoid colon or ileal prolapse is not commonly observed in bizarre medical condition, they may be the first symptoms of rectal/rectosigmoid injuries as a result of underlying colon disorder such as diverticular disease, spontaneous rupture or self-injury.
Highlights
Colon or ileal prolapse is a condition rarely observed and reported in daily surgical practice
Small intestine did not reveal any lesions but we found sigmoid colon diverticulosis complicated by the 3 - 4 cm long tear in the anterior side of rectosigmoid (Figure 3(d)), which formed the orfice for the small intestine to protrude through the rectal lumen directly out of the anus
Protrusion of small bowel loops or sigmoid colon through the anus is not commonly seen entity, there has been quite a few such cases described in the literature since Benjamin Brodie first had reported a case of transanal ileal evisceration in 1827 [1]
Summary
J, history number: 31272/ 09/10C20023) was admitted to the Department of General and Colorectal Surgery University of Medical Sciences in Poznań on January 3, 2010 because of a large intestine prolapsing through her anus. On first sight the surgeon who admitted the patient at the Emergency Department had the impression that he deals with typical but significant rectal mucosal prolapse. After a thorough examination it appeared to be a part of a large bowel with mesentery and epiploic appendices (most probably —sigmoid colon), without any signs of mucosal prolapse (Figure 1(a)). Due to the patient’s impaired mental status caused by a severe form of Parkinson’s disease, obtaining information concerning a supposed mechanism explaining her condition was impossible. On physical examination abdomen was soft, painless, without rebound tenderness, without distension, peristal-
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