A Case of Idiopathic Rectal Perforation Simultaneously Associated with Uterine Prolapse and Small Bowel Prolapse Through the Anus

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  • 子宮脱と肛門からの小腸脱出を同時に伴った特発性直腸穿孔の1例
  • 症例 子宮脱と肛門からの小腸脱出を同時に伴った特発性直腸穿孔の1例
  • ショウレイ シキュウ ダツ ト コウモン カラ ノ ショウチョウ ダッシュツ オ ドウジ ニ トモナッタ トクハツセイ チョクチョウ センコウ ノ 1レイ

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Abstract

A 75-year-old woman visited a neighboring hospital because she felt something to have prolapsed through the anus during defecation in the early morning, and was brought into our outpatient clinic by ambulance for confirmed prolapse of the uterine as well as prolapse of the small intestine through the anus. Physical examination revealed a prolapsed uterine and a prolapsed small intestine by more than 1 m in length through the anus. The prolapsed uterine was easily reduced, but the prolapsed small intestine was strangulated to show dark-red in color and our attempts failed to reduce it due to severe pain. Emergency operation was performed with a suspicion of small bowel prolapse caused by rectal perforation. During surgery, we confirmed a longitudinal hiatus about 8 cm in length at the anterior wall of the rectum, through which the ileum had prolapsed through the anus. The ileum was reduced rapidly as possible as we could, and the rectal perforation was closed by simple sutures. Since the prolapsed ileum also had a perforation due to necrosis, it was closed by sutures. The operation was completed after creation of sigmoidostomy with double orifices. Her postoperative course was uneventful and she was discharged from the hospital on the 29th postoperative day.

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