BMJ Case Reports 2012; doi:10.1136/bcr.12.2011.5316
  • Rare disease

Small bowel evisceration through the anus – report of a case and review of literature

  1. Rovan D’Souza1
  1. 1Department of General Surgery, The Royal Free Hospital, London, UK
  2. 2Department of Vascular Surgery, The Royal Free Hospital, London, UK
  1. Correspondence to Dr James Theo Berwin, jtberwin{at}


An 84-year-old lady with a history of chronic recurrent rectal prolapse, presented to accident and emergency with a significant portion of small bowel and mesentery protruding out of her anus. The small bowel was not contained within peritoneum, nor was this a pararectal herniation. On examination of the rectum, a longitudinal tear was found in the anterior rectal wall, through which the small bowel had prolapsed. Hours after reducing the small bowel back into the anus, it prolapsed a second time. Due to multiple co-morbidities, this patient was not fit for surgery. The defect was temporarily repaired on the ward and the patient treated with aggressive antibiotic therapy. The patient continued to deteriorate, became septic, acidotic, hypotensive and died a day later.


  • Competing interests None.

  • Patient consent Obtained.

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