An 8-month-old girl presented to a district hospital in Ghana with a 2 week history of frequent, blood stained diarrhoea. The patient was initially treated for presumed gastroenteritis and admitted for intravenous fluids. Two days after admission she was noted to have developed a mass protruding from her anus. This was initially thought to be a rectal prolapse and manual reduction was attempted. This was unsuccessful and she was referred to a regional paediatric unit for further intervention.

On arrival, she was tachycardic and in pain. Her abdomen was soft but diffusely tender. A short segment of bowel was prolapsed through the patients anus with a 5 cm × 3 cm necrotic mass attached to it (fig 1). The surgical team were alerted and once the patient was adequately fluid resuscitated a laparotomy was performed. The operative findings were an irreducible ileocaecal intussusception which had prolapsed through the rectum and become gangrenous. The patient had a right hemicolectomy to remove the affected bowel followed by an ileosigmoid anastomosis. The patient was able to open her bowels on day 1 postoperatively and was discharged home 8 days later in good condition.

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Figure 1

Anal protrusion of intussusception.

Anal protrusion of intussusception is a recognised complication.1^,2 However, it is rarely reported and confusion with rectal prolapse often leads to a delay in diagnosis. It is important to have a high index of suspicion as anal protruding intussusception requires surgical management and can be associated with high morbidity and mortality.3