World Journal of Colorectal Surgery

CASE REPORT
Year
: 2020  |  Volume : 9  |  Issue : 4  |  Page : 68--69

Spontaneous Rectal Perforation with Transanal Evisceration


Maria Sebastian Fuertes, Sonia Martinez Alcaide 
 Department of General and Digestive Surgery, La Ribera University Hospital, Valencia, Spain

Correspondence Address:
Dr. Maria Sebastian Fuertes
Km 1, Corbera Highway, Alzira (Valencia)
Spain

Abstract

We present the case of an 83-year-old woman that visited the emergency room of our hospital for correcting the transanal small bowel evisceration after a defecatory effort, without any history of rectal trauma. Emergency laparotomy was indicated, with the intraoperative finding of perforation in the anterior superior rectum, with a defect of approximately 3 cm. Due to the absence of fecaloid peritonitis, it was decided to perform a primary closure with double sutures. The patient evolved favorably.



How to cite this article:
Fuertes MS, Alcaide SM. Spontaneous Rectal Perforation with Transanal Evisceration.World J Colorectal Surg 2020;9:68-69


How to cite this URL:
Fuertes MS, Alcaide SM. Spontaneous Rectal Perforation with Transanal Evisceration. World J Colorectal Surg [serial online] 2020 [cited 2021 Sep 29 ];9:68-69
Available from: https://www.wjcs.us.com/text.asp?2020/9/4/68/305992


Full Text

 Introduction



Spontaneous perforation of the rectum with the evisceration of the small intestine is an extremely rare disease. The first case of spontaneous rectal perforation was described in 1827 by Benjamin Brodie in a middle-aged woman.[1] The available literature consists of only a few published articles, most of which are case reports and case series. At present, only 75 cases of spontaneous rectal perforation have been described in literature.

We present the case of an 83-year-old woman with a personal history of vaginal hysterectomy for symptomatic uterine prolapse, cholecystectomy with subcostal incision, bilateral blindness, and long-standing constipation.

 Case Report



The patient was referred to the hospital in the early morning for transanal evisceration of the small bowel loops after a significant defecation effort. She denied any history of rectal trauma. On physical examination, the patient presented transanal evisceration of the small intestine loops, showing congestion and edema as signs of intestinal distress [Figure 1]. After the findings, an emergency median laparotomy was indicated with the intraoperative diagnosis of perforation of the anterior wall of the upper rectum, with a wall defect of approximately 3 cm. Given the absence of fecaloid peritonitis, a primary closure was decided using a continuous stitch with a braided absorbable suture and subsequent reinforcement with a barbed suture. A tightness test was carried out by performing a hydropneumatic test, and satisfactory results were obtained. The viability of the small bowel loops was tested. As the only postoperative complication, the patient developed a paretic ileus on the second postoperative day, which was treated conservatively with a nasogastric tube and digestive rest. The patient evolved favorably and was discharged on the seventh postoperative day.{Figure 1}

 Discussion



The etiology of the spontaneous perforation of the rectum remains unknown. It predominantly occurs in elderly patients, although it has also been described in young patients without previous pathology.[2] Several studies point to a previous history of rectal prolapse as a cause, together with a history of chronic constipation. The alteration of the rectal irrigation that causes prolapse together with a worse irrigation of the antimesenteric border along with a defecation effort with increased intra-abdominal pressure would predispose to rectal perforation.[3],[4] Spontaneous rectal perforation is a pathological condition with a very high mortality. Resection of the affected segment with rectosigmoid anastomosis and eventual protective ileostomy can be considered as the treatment of choice, although this will ultimately depend on intraoperative findings (such as peritonitis and viability of the small bowel loops) or hemodynamic stability of the patient, among other factors. If the conditions are unfavorable, a Hartmann intervention may be necessary. In the case that we present, because of the small defect located in the anterior wall of the superior rectum and the absence of the associated fecaloid peritonitis, the primary suture was enough as the unique treatment.

 Conclusion



Rectal perforation with transanal evisceration is an unusual surgical pathology related to a history of rectal prolapse and chronic constipation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Al-Abkari HA. Spontaneous rupture of the rectum with evisceration of omentum through the anus: A case report and review of the literature. Ann Saudi Med 2000;20:246-7.
2Salvador Rosés H, Falgueras Verdaguer L, Marinello F, Farrés Coll R, Codina Cazador A. Spontaneous perforation of the rectum with transanal evisceration of the small bowel: A case report and review of the literature. Cir Esp 2017;95:299-301.
3Morris AM, Setty SP, Standage BA, Hansen PD. Acute transanal evisceration of the small bowel: Report of a case and review of the literature. Dis Colon Rectum 2003;46:1280-3.
4Papapolychroniadis C, Kaimakis D, Giannoulis K, Parlapani A, Karpini E, Georgiou M, et al. Spontaneous rupture of the rectosigmoid with small bowel evisceration through the anus. Tech Coloproctol 2004;8(Suppl 1):s126-8.