Transrectal small bowel evisceration after abdominal crush injury

Transrectal small bowel evisceration (TSBE) is a rare entity that can occur after traumatic injuries. It has been described after impalement, sexual assault, blunt abdominal trauma, and swimming pool drain suction. The authors encountered such a case in a 4-year-old by following a crush abdominal injury. A laparotomy was performed. The eviscerated bowel was pulled inside the abdominal cavity, revealing the rectal perforation. A portion of devascularized ileum was resected, a primary bowel anastomosis was performed, and the longitudinal rectal laceration was repaired with a two-layered closure. There was no fecal soilage, and no protective colostomy was performed. The mortality and morbidity of TSBE are usually related with the severity and type of trauma. The mesenteric laceration and concomitant injuries can cause significant bleeding leading to a hemorrhagic shock and multiorgan failure.