Management of a giant rectal prolapse with bowel evisceration in a low-resource setting

Rectal prolapse (RP) involves full-thickness rectal protrusion through the anus, often associated with anatomical changes such as a deep pouch of Douglas. Delay in treatment can lead to giant prolapse (>10 cm) and, rarely, necrosis with bowel evisceration. We report a 36-year-old male with giant RP complicated by evisceration of bowel. An exploratory laparotomy was performed. The intraoperative findings included a 15 cm prolapsed rectum with an anterior wall tear through which loops of bowel herniated. Only 93 cm of jejunum and 10 cm of terminal ileum remained viable. Additional findings included a deep pouch of Douglas and an edematous pelvic floor. We performed an enterectomy of the gangrenous small bowel loops with divided stoma (end jejunostomy and mucus fistula). The prolapsed rectum was repaired with a three-point fixation to the anterior abdominal wall and the iliopsoas fasciae on either side of the rectum, after an upward traction. He died 30 h after surgery from septic shock. Eviscerated bowel, a rare complication of neglected RP, is associated with challenges and increased mortality in a resource-poor setting. There is a need for health education to promote early presentation among individuals with RP.