Transanal evisceration of small bowel : case report and review of the literature : case report

We report an unusual case of small bowel evisceration through the anus in an otherwise healthy 24-year old African male who denied any social or traumatic anal penetration. He describes a prolapsing rectum since childhood that was never investigated. Unfortunately he had also spent two years in prison in the past during which years he had smuggled 'dagga condoms' intra-rectally on several occasions. At laparotomy we retrieved small bowel through an anterior rectal perforation and performed an extensive resection. Our operative management was straightforward and we looked for possible diagnostic clues intra-operatively including histological sampling. An extensive photographic iconography illustrates the case. Our final diagnosis remains uncertain. The prolapsing rectum has not recurred since the laparotomy. We reviewed the literature for reports on 'transanal evisceration' and associated causes. Our discussion includes the possible non-traumatic differential diagnosis.