Spontaneous transvaginal evisceration of small intestine in a case of long-standing uterine and rectal prolapse

Spontaneous transvaginal small bowel evisceration, without recent trauma or surgery, is extremely rare. Complications include bowel obstruction, perforation, gangrene, septicaemia and death, requiring urgent surgical intervention. We report a case of a woman in her late 60s, who presented with 70-75 cm of small intestine eviscerated through the vagina, alongside a long history of uterine and rectal prolapse. Due to oedema in the intestine and mesentery, a vaginal reduction attempt failed. An emergency lower midline laparotomy was performed with a gynaecologist present. The eviscerated ileum was reduced, viability confirmed and repairs were made to the posterior vaginal vault defect and the peritoneal rent in the Douglas pouch. A Thiersch procedure was performed for the prolapsed rectum. Definitive surgery for the prolapsed uterus and rectum was deferred due to low condition. She recovered and was discharged on the 10th postoperative day but died from a myocardial infarction 3 months later.