Hemorrhagic necrosis of small bowel following small bowel obstruction as a late complication of sex reassignment surgery—a gap in transgender care

Abstract

For decades, Thailand has been at the forefront of sex reassignment surgeries. The neovagina created by recto-sigmoid vaginoplasty is much more complex procedure when compared with penile skin version technique, but yielded more satisfactory functional outcomes. We reported an unusual case of life-threatening small bowel obstruction following previously successful recto-sigmoid vaginoplasty in a transgender woman. Transgender individuals have unique healthcare needs. However, various gaps still exist to provide multi-disciplinary care for these patients. The rate of adhesive small bowel obstruction is highest in the early period of any intra-abdominal post-operative surgeries, but the risk remains life-long. Transgender women receiving complicated vaginoplasty should be instructed to continue long-term follow-up to ensure early detection and management of post-operative complications.

Updates on feminizing genital affirmation surgery (vaginoplasty) techniques

“…Data on complications associated with intestinal vaginoplasty specifically are sparse. There are published case reports describing intestinal necrosis postoperatively with significant sequelae to patients, 17,18 but in general, there are significant knowledge gaps about overall outcomes in the transgender patient population. In a series of 24 patients who underwent intestinal vaginoplasty as a secondary procedure, van der Sluis et al reported that 1 in 8 of the intestinal neovaginas were removed for postoperative complications and almost 80% underwent at least one genital reoperation such introitoplasty.…”