Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review

Abstract

Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred. Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess.

Evisceración intestinal transvaginal incarcerada con perforación intestinal después de una colporrafia con malla. Reporte de un caso

“…También se puede utilizar un abordaje mixto, primero vaginal para liberar las asas en caso de incarceración y luego abdominal con laparotomía para realizar la evaluación, resección y/o anastomosis intestinal, tal como se procedió con el caso que se presenta 1,8 . El abordaje laparoscópico ha sido utilizado cuando la paciente se encuentra hemodinámicamente estable, sin las complicaciones ya mencionadas 15,16 .…”

Laparoscopic repair of the vaginal cuff dehiscence: Dehiscence occurring after the first sexual intercourse after the laparoscopic modified radical hysterectomy

“…There are few reports on VCD repair by the total laparoscopic approach describing its safety and efficacy. This is the first and second case in which total laparoscopic repair for VCD after TLmRH was performed.…”

“…[1][2][3] Among reported cases, cases of complete VCD with bowel evisceration are rare. Although there are few reports of total laparoscopic repair for VCD, 4,5 we performed this procedure in two cases. We reported two cases of complete VCD complicated by bowel evisceration after total laparoscopic modified radical hysterectomy (TLmRH), which was triggered by the first sexual intercourse after primary surgery.…”

Spontaneous vaginal cuff dehiscence and evisceration of multiple organs

“…No absolute standard of surgical options has been established for patients with vaginal cuff dehiscence and multiorgan evisceration, which depend on the patient's age and vital signs, the vitality of the evisceration, and the presence of mechanical damage. [10] Abdominal surgery allows complete inspection of organs and targeted treatment (i.e., resection, suspension or reconstruction). Perineal surgery is minimally invasive but may be under consideration when the patient's vital signs are stable and when there is no peritonitis or ischemic injury.…”