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- W2023341259 abstract "A rectal prolapse is a protrusion of the rectum through the anal orifice. However, prolapse can take a variety of forms. One is complete rectal prolapse (procidentia) where all layers of the rectum protrude through the anus. Another is an occult rectal prolapse, where there is internal intussusception of rectal tissue either without protrusion through the anus or with protrusion only on straining. The third and most common variant is a mucosal prolapse with protrusion of distal rectal tissues during straining or at defecation. Complete and occult prolapse are more common in elderly women and have been associated with poor tone in pelvic muscles, chronic straining at stool and fecal incontinence. The primary abnormality is intussusception of the rectum that is facilitated by weak fascial attachments, a redundant rectosigmoid colon, vertical orientation of the rectum and a weak anal sphincter. Complications apart from fecal incontinence include rectal bleeding, a solitary rectal ulcer and rectal ischemia. A much rarer complication is outlined below. An 88-year-old woman presented to the Emergency Department with anal discomfort and a more prominent rectal prolapse. She had been known to have a complete rectal prolapse for the preceding 8 years, but had not had surgery because of atrial fibrillation and severe cardiac failure. She lived at home with help from family and community support. Anal examination revealed evisceration of small bowel (Fig. 1). At emergency laparotomy, she had a large hole in the ante-mesenteric wall of the upper third of the rectum corresponding to the apex of the chronic rectal prolapse (Fig. 2). The distal half of her small bowel had protruded through this hole into the lumen of the rectum and was subsequently passed per anus. The small bowel was replaced in the abdominal cavity but was subsequently resected because of ischemia. The rectum was also resected and the sigmoid colon was fashioned into an end-stoma. Histological evaluation of the rectum revealed ischemic changes on the ante-mesenteric wall adjacent to the hole. The case illustrates ischemic perforation at the apex of a chronic rectal prolapse with the subsequent development of small bowel evisceration per anus." @default.
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- W2023341259 date "2007-06-01" @default.
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- W2023341259 title "Gastrointestinal: Small bowel evisceration with chronic rectal prolapse" @default.
- W2023341259 doi "https://doi.org/10.1111/j.1440-1746.2007.04981.x" @default.
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