Spontaneous Rectal Perforation With Transanal Small Bowel Evisceration: A Rare Complication of Chronic Rectal...

Small bowel evisceration through a rectal perforation is a rare but severe surgical emergency. It typically occurs following trauma or in elderly patients with a history of chronic constipation, rectal prolapse, prior abdominal surgeries, or multiple vaginal deliveries, which weaken the pelvic floor. While rectal and rectosigmoid perforations in patients with rectal prolapse are uncommon, the herniation of the small bowel through a perforation, resulting in evisceration per rectum, is an extremely rare presentation. Fewer than 100 cases of per rectal small bowel evisceration have been reported in the literature over the last 200 years, with the first case described in 1827. Among the published English literature, only 38 cases of nontraumatic rectal perforation with small bowel evisceration have been reported. Here, we present a rare case of spontaneous rectal perforation with transanal evisceration of the small bowel.