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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Malik C. I., Hanavadi S., Siddiqui M., Oke T.
Small bowel herniation via the anus is an extremely rare but serious condition. It is usually due to perforation of the peritonealised portion of the rectum on the anti-mesenteric border. We report and display small bowel evisceration via the anus in a 90 year old lady who was referred with a one month history of ''rectal prolapse''. Examination revealed several loops of viable small bowel prolapsing out of the anus. She underwent a Hartmann's procedure but became septic postoperatively and died. Although anal evisceration is often a complication of rectal prolapse, unusually our patient was found to have a stercoral perforation on histology. We describe the aetiology and presentation of this condition from the time of Benjamin Brodie in the 19th century to the present day. Fluid resuscitation, antibiotics and urgent surgery to cleanse and reduce any viable loops of bowel are the cornerstones of management. Transrectal reduction of bowel loops has poor results compared to trans-abdominal reduction. Small bowel evisceration is a surgical emergency and must be differentiated from rectal prolapse and treated promptly for it is a life-threatening condition.