Emergency laparoscopic repair of coitus-induced vaginal cuff dehiscence: a case report

Abstract

Background: Vaginal cuff dehiscence is a rare but potentially grave complication after total hysterectomy. Abdominal or pelvic contents are at risk of evisceration through the vaginal opening. It is associated with significant risk for patient morbidity, such as peritonitis, bowel injury, and sepsis. Case presentation: We report a case of vaginal cuff dehiscence in a 45-year-old multiparous Taiwanese woman who had undergone abdominal total hysterectomy and presented with vaginal cuff dehiscence precipitated by sexual intercourse. Immediate laparoscopic repair was done. Few authors have reported the utilization of the laparoscopic approach. It allows thorough inspection, visualization, and irrigation of the abdominal cavity. It is also associated with fewer intraoperative and postoperative complications. Conclusion: Laparoscopic repair is a safe treatment option to manage vaginal cuff dehiscence after total hysterectomy.A 45-year-old multiparous Taiwanese woman had undergone abdominal total hysterectomy for adenomyosis and endometrioma at a local hospital 53 days

Experience in the Management of Vaginal Cuff Dehiscence and Evisceration: A Retrospective 37-Year Single-Center Study

“…According to the surgical route of the procedure, TH is divided into transabdominal hysterectomy, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, laparoscopic hysterectomy (LH), and robotic hysterectomy. VCD(E) is possible from any type of TH, but its prevalence varies widely depending on the TH route ( 13 ). The influence of the surgical route and type of cuff closure on the incidence of VCD(E) has been discussed with conflicting theories.…”

“…Consistent with published literature, the median TH-to-VCD(E) interval was 3.13 months in our study; half of the patients experienced VCD(E) within 3 months. The recommended time to resume sexual activities after TH was approximately 8 ( 13 , 26 ) to 12 weeks ( 26 ) in the literature. Based on our experience, we suggest that patients resume normal sexual activities at least 3–6 months after TH.…”

“…On the other hand, if patients present with complaints after TH, doctors should promptly conduct a medical history and physical examination. VCD(E) is a clinical diagnosis ( 13 , 27 ) that should be made based on a history of TH and vaginal examination. Notably, people who underwent TH for obstetrical reasons could also experience VCD(E) ( 28 ).…”

Prevention and management of vaginal cuff dehiscence: an updated review

“…Though there is no consensus on the most optimal route of repair, minimally invasive approaches (vaginal, laparoscopic, or combination) have become the predominant method of management in recent literature, with laparotomy reserved for patients with hemodynamic instability or necrotic bowel [1,2,11,37,38,[41][42][43][44][45].…”

“…Similar to the management of initial cuff closure, there is no one recommended way to close the cuff after a dehiscence has occurred [1,2,[39][40][41]. Some authors favor monofilament sutures for the theoretical advantage of reducing infection [42,48,49]. In cases of hematoma or abscess, a vaginal drain may be placed [40,42,48].…”