Spontaneous Transanal Small Bowel Evisceration with Distinct CT Findings: A Case Report

Introduction: Transanal small bowel evisceration is an extremely rare and life-threatening surgical emergency that primarily occurs in debilitated elderly patients. Preoperative computed tomography (CT) can be useful for identifying the viability of eviscerated small bowel and other intra-abdominal pathologies. Case Presentation: In this study, we report the case of an 81-year-old woman who presented with sudden anal protrusion of small bowel loops. Computed tomography (CT) demonstrated a rectal wall defect, pneumoperitoneum, and herniation of the small bowel with features suggestive of strangulation. Emergency laparotomy revealed a firmly impacted ileal segment plugging a perforation at the rectosigmoid junction, likely due to increased intraabdominal pressure, necessitating small bowel resection and the Hartmann procedure. Early diagnosis and prompt surgical intervention led to a favorable postoperative course. Conclusion: This case highlights the critical role of CT in identifying rectal perforation and intrarectal small bowel evisceration.