Laparoscopic assessment and transvaginal reparation of post-coital vaginal cuff dehiscence with bowel evisceration: a case report

Sendy, Feras; Simone, Luisa De; Albaut, M.; Lambert, Antonin; Nohuz, E.

doi:10.11604/pamj.2020.35.118.2136

Cited by 2 publications

(4 citation statements)

References 6 publications

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“…Notably, these two methods are simple and less invasive than cystoscopy. To restore well-vascularized tissue, debridement of the necrotic tissue of the vaginal cuff is necessary ( 34 ). Pathological examination was conducted in one patient in our cohort, revealing no particular lesions other than acute and chronic inflammation, similar to previous reports ( 10 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

“…To restore well-vascularized tissue, debridement of the necrotic tissue of the vaginal cuff is necessary ( 34 ). Pathological examination was conducted in one patient in our cohort, revealing no particular lesions other than acute and chronic inflammation, similar to previous reports ( 10 , 34 ). Jennifer K ( 18 ) compared the vaginal cuff specimens of VCD(E) with those of non-VCD(E) patients and found that VCD demonstrated dramatically higher levels of inflammatory cells.…”

Section: Discussionmentioning

confidence: 99%

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

Cao

Dai

2022

Front. Surg.

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PurposeVaginal cuff dehiscence (and evisceration) (VCD(E)) is an extremely rare and late-onset complication of total hysterectomy (TH). Limited evidence is available to guide clinicians in managing VCD(E). This study aimed to summarize the clinical characteristics of patients with VCD(E) treated in our center and share our experience in managing VCD(E).Patients and methodsFrom 1983 to 2020, a total of 14 cases of VCD(E), including 10 cases in our hospital and 4 cases in other hospitals, were included. Medical records were reviewed to summarize the clinical features and management of VCD(E).ResultsThe incidence of VCD(E) in our hospital was 10/46,993 (0.02%), and all 10 patients underwent laparoscopic hysterectomy. The median TH-to-VCD(E) interval was 3.13 months (8 days–27.43 months), and 11/14 (78.57%) patients experienced VCD(E) after coitus. The 3 major symptoms included abdominal pain in 11 patients, irregular vaginal bleeding in 8, and sensation of bulging or prolapsed organs in 4. Except for 2, most patients presented to our hospital within 72 h since the onset of the discomfort. All 14 cases were diagnosed through speculum examination: 3 had simple VCD, and 11 had VCDE. The protruding bowels of 4 patients were immediately manually repositioned in the emergency department without anesthesia. Regarding the surgical approach, 11 patients underwent simple transvaginal, 2 patients underwent laparoscopic-vaginal combined (transvaginal cuff closures), and 1 patient underwent laparoscopic. All but 1 patient did not undergo resection of the eviscerated organs. The median follow-up period was 39.33 (7.9–159.33) months. No patients showed any evidence of recurrence to date.ConclusionsLaparoscopic hysterectomy is a risk factor for VCD(E), and early initiation of sexual intercourse is the most common trigger of VCD(E). Clinicians should educate patients to postpone sexual intercourse for at least 3–6 months after TH. Immediate medical attention and patient-specific surgical management are crucial to avoid serious complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Cao

Dai

2022

Front. Surg.

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“…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].…”

Section: Managementmentioning

confidence: 99%

“…The bladder and rectum may require further dissection to allow at least 1 cm of full-thickness bite during closure [4,5]. 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].…”

Section: Managementmentioning

confidence: 99%

Prevention and management of vaginal cuff dehiscence: an updated review

Pinho

Liu

Kim

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewMinimally invasive hysterectomy has gained popularity because of its many benefits. However, laparoscopic and robotic assisted hysterectomy have been associated with increased risk of vaginal cuff dehiscence. This review is meant to address risk management and prevention of vaginal cuff dehiscence in patients undergoing minimally invasive hysterectomy. Recent findingsRecent findings in the literature focus on addressing modifiable risk factors in patients and on using good surgical technique to help minimize the risk of vaginal cuff dehiscence.

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Laparoscopic assessment and transvaginal reparation of post-coital vaginal cuff dehiscence with bowel evisceration: a case report

Cited by 2 publications

References 6 publications

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

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

Prevention and management of vaginal cuff dehiscence: an updated review

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