Spontaneous transanal small bowel prolapse in a young patient

Transanal small bowel evisceration is an exceedingly rare and life-threatening condition, predominantly affecting elderly patients with chronic rectal prolapse or pelvic floor dysfunction. However, this case report presents an unusual occurrence in a 30-year-old woman with no prior history of rectal prolapse, anorectal surgery, or other predisposing factors. She arrived at the emergency department with a visible small bowel prolapse through the anus, initially mistaking it for hemorrhoids. Emergent laparotomy was performed, involving the reduction of the prolapsed small bowel through a rectal defect, resection of ischemic segments, and primary anastomosis. A temporary diverting sigmoidostomy was created to protect the rectal repair. The patient had an uneventful recovery and was discharged on postoperative day six. We discuss pathophysiology, clinical presentation, and management strategies, emphasizing the role of fecal diversion in optimizing patient outcomes. • transanal small bowel evisceration in a healthy 30-year-old without predisposing factors. • No pneumoperitoneum on imaging, highlighting the importance of clinical suspicion. • Emergency laparotomy with bowel repair and fecal diversion ensured recovery. • Sigmoidostomy protected the rectal repair and facilitated a smooth postoperative course. • Expands understanding of at-risk patients and underscores the need for timely intervention.