Blunt abdominal trauma with transanal small bowel evisceration
A 48-year-old female presented to the emergency department with complaints of severe abdominal pain and protrusion of bowel loops through the anus. She gave a history of assault with a direct kick over the lower abdomen 8 hours before presentation. On presentation, she was conscious with a pulse rate of 98/minute and blood pressure of 100/60 mmHg. The abdomen was tender with mild guarding. Loops of congested small intestine were seen protruding through the anus []. There were no other associated injuries or hematuria. The patient was resuscitated and transferred for urgent laparotomy. During laparotomy, a longitudinal rent was seen at the antimesenteric border of rectosigmoid region [] with ileal loops entering the large bowel lumen. There was no hemoperitoneum or fecal contamination of peritoneal cavity. No other solid organ injury was detected. Small bowel loops were gently reduced in the abdominal cavity; warm moist packs applied and viability ascertained. Primary closure of sigmoid done in two layers and abdomen closed after thorough peritoneal lavage. The patient was under intensive care for 48 hours and discharged on the seventh postoperative day. The patient is healthy on two months follow-up.