Evisceration of bowel through the vaginal vault is an extremely rare condition and is considered to be a surgical emergency. We present the case of an 83-year-old female who was brought to the emergency department with a vaginal prolapse complicated by evisceration of small bowel. A midline laparotomy was performed for reduction of the bowel with a subsequent vaginal repair. We present this case due to its rarity and high-reported mortality rate.
First described by Dr Alexandre Couvelaire in 1911, a Couvelaire uterus is a rare complication of severe placental abruption (PA), which is diagnosed by the direct visualization of the uterus. There has been only one case report thus far that reported of an intraperitoneal bleed due to PA resulting in a poor outcome. We present a rare and serious case of Couvelaire uterus resulting in haemoperitoneum with a good outcome (live healthy infant, uterus preservation and total blood loss of 800 ml) in a primigravida with no prior risk factors and low-risk pregnancy other than a complete placenta praevia diagnosed during anatomy scan, which subsequently was reported as clear of cervix in third trimester ultrasound scan. She was diagnosed with placenta abruption and pre-eclampsia post-partum. Most cases of PA cannot be predicted or prevented. However, in some cases, close monitoring and timely decision-making can prevent adverse maternal and foetal outcomes.
Objective: To explore the ease and effectiveness of placing a cervical suture preconception using a laparoscopic technique.Design: A case study with systematic literature review.Setting: PIVET Medical Centre, a private facility providing comprehensive services over 35 years in gynaecology, andrology and reproductive endocrinology for infertility and recurrent pregnancy loss.Patients: Case report of a 35 year old woman with recurrent mid-trimester pregnancy losses and well-define cervical incompetence.Intervention: Preconception placement of cervical suture by laparoscopic trans-abdominal cerclage (LTAC) as a day case. Main outcome measure: Details of ensuing pregnancy.Results: Conception without delay and normal pregnancy with delivery by elective caesarean section near term of healthy 2645 g female infant. Conclusion:We are impressed with the ease of the LTAC technique which appears likely to have fewer complications than traditional vaginal techniques, as well as speedier recovery compared to a laparotomy approach.
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