Small bowel transanal evisceration mimicking a rectal prolapse. A case report and review of literature.

Transanal intestinal evisceration is a very uncommon and dramatic occurrence, linked most frequently to rectal prolapse rupture or, very rarely, to traumatic pathology. The Authors describe a case of a 74-year-old female patient who required urgent hospital admission because of a seemingly strangulated rectal prolapse. During surgical preparation the protruding mass was recognized as small bowel loops herniating from the anus. Evisceration was due to spontaneous rectal wall rupture, most likely caused by increased abdominal pressure and consequent breach through the weakened rectum. Surgical treatment consisted in small bowel resection combined with an Hartmann's procedure. Spontaneous rectal rupture without a pre-existing rectal prolapse is a rather infrequent and challenging condition; its mechanism is still incompletely explained. The management is surgical and may range from primary repair up to extensive intestinal resection to include a defunctioning colostomy.
Key Words: Rectal prolapse, Spontaneous rectal rupture, Transanal evisceration.