eP487 - Sigmoid Colon Prolapse Through an Anterior Rectal Perforation

Purpose/Background: Rectal prolapse is a full thickness telescoping of the rectum through the anus. It occurs most frequently in older multiparous women due to pelvic floor muscles laxity. It is associated with redundancy of the sigmoid colon, levator ani diastasis, as well as loss of the sacral rectal attachments. Although rectal prolapse is a well-established diagnosis, here we discuss a unique case of sigmoid colon prolapse through an anterior rectal perforation in a young 35-year-old female.Methods/Interventions: A 35-year-old female presented to the emergency department with one day of lower abdominal pain after straining to have a bowel movement. Her past medical and surgical history included tobacco abuse, morbid obesity, hypertension, bipolar disorder, Crohn’s disease in remission, and Roux-en-Y gastric bypass (2009). The patient presented to the ED due to worsening abdominal and rectal pain with persistent protrusion from the rectum. In the emergency room, the patient was hemodynamically stable with labs within normal limits. On exam, the patient had a large loop of bowel protruding from the anal canal. Reduction at bedside was attempted with sedation; however the prolapse recurred shortly after. The patient was taken to the operating room for a diagnostic laparoscopy. Upon entry into the abdomen, inspection of the pelvis was difficult as the patient had a large uterus, however murky fluid as well as a loop of sigmoid colon was seen to be headed down into the pelvis. Reduction of the bowel with laparoscopic port was unsuccessful and therefore, a hand-assisted gel port was placed. At this time, the sigmoid colon was successfully reduced back into the abdomen revealing a 7 cm defect in the anterior rectum, through which the sigmoid colon had prolapsed into the anus. The procedure was then converted to an open laparotomy and the patient underwent partial proctosigmoidectomy with an end colostomy creation.Results/Outcomes: The patient did well and was discharged on post-operative day three. Patient did later represent with a superficial skin dehiscence that resolved with the placement of a wound vac. Post operative pathology of the specimen showed acute and chronic inflammation with granulation tissue formation and acute serositis without any malignancy.Conclusion/

Discussion: Rectal perforation is usually seen in cases of traumatic injuries, ischemia or malignancy. However, this is a striking case as this patient is a young and relatively healthy female with the etiology being increased intraabdominal pressure secondary to straining.Sigmoid colon prolapseA loop of colon seen through the anal canal