Rectal Prolapse Concomitant with Uterovaginal Prolapse Protects the Ileum from Necrosis in Transanal Ileum Evisceration through a Traumatic Tear on the Sigmoid Wall

Abstract

Eviscerated ileum passing through a traumatic tear on the sigmoid wall is a rare case and all the cases reported previously showed that the eviscerated intestines were necrotic. However, in this case, although the huge size of eviscerated intestine had already exceeded the intestinal ischemic time, the small intestine outside the anus was not necrotic. Here we report the case of a 73-year-old female who presented with evisceration of the small intestine out of her anus as long as 200 cm 7 h before. The eviscerated small intestine (ileum) appeared still viable and there were no signs of pain, obstruction, or peritonitis. An intermittent rectal concomitant with uterovaginal prolapse had been experienced by the patient before. On surgery, the ileum was not necrotic and pulled back out of the sigmoid wall tear. The cardinal uterosacral ligament may have an important role in maintaining the uterovagina in place. When this ligament loses its ability to anchor the uterovagina to the sacrum, both the uterovagina and the rectum will lose their fixation to the sacrum and prolapse will occur. Hence, the rectum located posterior to the uterovagina also relieves its squeeze pressure so that it will not disrupt the blood supply of the ileum when the ileum enters through the rectal lumen. Rectal concomitant with uterovaginal prolapse is an important factor to maintain the viability of the eviscerated intestine. Therefore, surgeons are still able to make better preparation before performing surgery.

Keywords

• evisceration of the ileum
• cardinal uterosacral ligament
• necrosis