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Transanal small bowel evisceration secondary to rectal perforation in a patient with chronic uterine prolapse: A case
Prakash Shah1, Utsav Yadav1, Arpan Niroula2
1Department of Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.
Introduction:
Transanal evisceration of small bowel through a rectal perforation is a rare surgical presentation, often associated with rectal prolapse. Its occurrence with uterine prolapse is an uncommon finding.
Case Presentation:
We report a case of a 50-year-old female with untreated third-degree uterine prolapse and COPD, who presented with transanal evisceration of approximately 100 cm of small bowel following coughing episodes. There was no history of rectal prolapse, trauma, or constipation. After ICU stabilization for sepsis, COPD exacerbation, and diabetic ketoacidosis, she underwent exploratory laparotomy, primary rectal repair, and diverting loop ileostomy. Postoperative recovery was uneventful.
Discussion:
Our case adds further evidence to the limited body of literature suggesting a rare complication of chronic uterine prolapse leading to spontaneous rectal perforation. The rise in intra-abdominal pressure from coughing likely triggered the event.
Conclusion:
Uterine prolapse may independently predispose to rectal perforation and bowel evisceration. Early recognition and timely surgical intervention are key to favorable outcomes.
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