Spontaneous evisceration of small bowel through the rectum in the background of rectal prolapse

Small bowel evisceration secondary to rectal prolapse is an uncommon complication with significant morbidity and mortality if left untreated. We report a rare case of the spontaneous evisceration of the small bowel through the rectum in the background of rectal prolapse. A 73-year-old female presented to the emergency treatment unit with sudden worsening of her rectal procidentia (rectal prolapse) and pain for 3 h precipitated by straining at defecation. She had a history of complete rectal prolapse for 4 years and three uncomplicated vaginal deliveries. On examination, she was found to have evisceration of the small bowel through the anus without any evidence of strangulation. Emergency laparotomy was performed and small bowel was reduced into the abdomen with ease. She was found to have a linear tear on the anterior wall of the rectum. Primary repair of the rectal defect was carried out and a proximal defunctioning ileostomy was created. Histology was unremarkable and the recovery was uneventful. Old age, history of previous vaginal deliveries, and long-standing rectal prolapse were probable risk factors in this patient. Delay in treating this condition may result in significant morbidity and even mortality. Therefore, timely intervention is necessary.