Swimming pool filter-induced transrectal evisceration in children: Australian experience

Fatal Drowning Caused by A Swimming Pool Drainage System

ABSTRACT

In swimming pools, malfunctions in the pool water drainage system can result with severe injuries, or even death, and mostly children are affected by these accidents. In this case report, the death scene and postmortem examination findings of a 12-year-old girl, who was trapped by her feet in the pool water drainage system, are reported. The external examination revealed ecchymotic areas with abrasions on both lower legs and both feet, suggesting suction of both feet through the uncovered pool drainage system opening. To prevent such accidents, safety practices related to the water circulation system should be developed in swimming pools and similar areas; children should be supervised at all times; and emergency medical teams, as well as lifeguards, should be available for immediate intervention.

Spontaneous evisceration of small bowel through the rectum in the background of rectal prolapse

Small bowel evisceration secondary to rectal prolapse is an uncommon complication with significant morbidity and mortality if left untreated. We report a rare case of the spontaneous evisceration of the small bowel through the rectum in the background of rectal prolapse. A 73-year-old female presented to the emergency treatment unit with sudden worsening of her rectal procidentia (rectal prolapse) and pain for 3 h precipitated by straining at defecation. She had a history of complete rectal prolapse for 4 years and three uncomplicated vaginal deliveries. On examination, she was found to have evisceration of the small bowel through the anus without any evidence of strangulation. Emergency laparotomy was performed and small bowel was reduced into the abdomen with ease. She was found to have a linear tear on the anterior wall of the rectum. Primary repair of the rectal defect was carried out and a proximal defunctioning ileostomy was created. Histology was unremarkable and the recovery was uneventful. Old age, history of previous vaginal deliveries, and long-standing rectal prolapse were probable risk factors in this patient. Delay in treating this condition may result in significant morbidity and even mortality. Therefore, timely intervention is necessary.

[Transanal evisceration of small bowel caused by impalement in children: about a case]

L'éviscération transanale de l'intestin grêle par empalement est exceptionnelle chez l'enfant. Nous rapportons l'observation d'un adolescent de 11 ans reçu à 2 heures d'une issue des anses grêles à travers l'anus suite à une chute avec réception sur un morceau de bois pointu. L'examen clinique avait objectivé un bon état général, une issue, par l'anus, d'environ 25 cm d'intestin grêle viable et un abdomen sensible dans son ensemble. Le bilan biologique préopératoire était normal et aucune imagerie n'était réalisée. Après une réanimation, l'exploration chirurgicale avait mis en évidence un liquide séro-hématique (300 ml) et une issue d'environ 60 cm d'anse grêle inflammatoire à travers une brèche d'environ 5 cm de la paroi antérieure du rectum. Une réduction des anses grêles éviscérées par traction douce, une réparation de la paroi rectale par des points séparés, une toilette et un drainage ont été réalisés. Le patient était sous antibiotique à large spectre. Les suites opératoires étaient simples avec une reprise du transit à J2 post-opératoire. La sortie a été autorisée à J7 post opératoire. Après un recul d'un mois, la patiente a été revue en consultation et l'examen clinique était normal.

Fatal entrapment in a pool drainage system: a case report

Swimming pool suction injuries are rarely encountered in forensic medicine. Infants under 8 years of age are most frequently involved in such accidents with high risk of serious injuries and fatal consequences due to drowning. We report, for the first time, a case of a 13-year-old boy trapped at the abdomen by an uncovered suction drainage hole. External examination of the body revealed a round ecchymosis which had the same diameter as the pool drain. Post-mortem examination established that death had occurred due to drowning, possibly in combination with traumatic shock from the suction mechanism involving the intestinal loops. Furthermore, this case may be remarkable as it raises other medico-legal issues regarding the safety standards at swimming pools, including pool management and lifeguard attendance. Preventative measures are needed in order to make sure this sort of injury or death does not occur. Moreover, the awareness of the occurrence of these accidents should be increased.

Transanal evisceration caused by rectal laceration

Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.

Transanal evisceration of small bowel-a rare surgical emergency

Transanal evisceration of small bowel is an extremely rare surgical emergency. This is the condition in which the small bowel herniates through breach in the anterior rectal wall and seen eviscerating through the anal canal. It is challenging for a surgeon to deal and manage such a case during emergency, especially if he hasn't dealt with such condition earlier. The present case reported is of 68 year old lady referred to an institution with history of transanal herniation of small bowel for three days duration, following manual reduction of chronic rectal prolapse. The case report illustrates aetiology, management & factors influencing the outcome of this rare emergency have been discussed.