Transvaginal evisceration after laparoscopic adrenalectomy in neurofibromatosis

Abstract

Transvaginal evisceration is a rare complication of hysterectomy. We describe this event following adrenalectomy for pheochromocytoma in a patient affected by neurofibromatosis. This is the first case reported in the literature following laparoscopic surgery. Prompt emergency intestinal reduction and vaginal cuff repair is required to prevent ischemia of the eviscerated bowel. Pneumoperitoneum, passage of stools, or an unknown connective tissue dysplasia due to genetic abnormalities might have contributed to this unpredictable event. The general surgeon must be aware of this rare but challenging gynecological complication.

Post blunt trauma abdomen transvaginal omental evisceration: a rare case report

“…Previous vaginal operations and enteroceles are also risk factors for vaginal evisceration. 14 Poor technique, hematoma, coitus before healing, advanced age, irradiation, corticosteroid medication, penetrative trauma or rape, previous vaginoplasty, use of the Valsalva manoeuvre, pelvic radiation, hypoestrogenism and devascularization from previous surgery are all known risk factors. 8,15 Peritonitis, intestinal damage, necrosis and sepsis can all occur as a result of intestinal evisceration.…”

Coitus induced vaginal evisceration in a premenopausal woman: a case report

“…The risk groups for trans-vaginal bowel evisceration include the elderly, postmenopausal women and female patients after vaginal or laparoscopic hysterectomy [ 4 ]. Ramirez, on a review of the literature on 59 eviscerations, highlighted as risk factors: a postmenopausal state, trans-vaginal hysterectomy, and an increase in abdominal pressure [ 9 ].…”

“…In premenopausal patients, evisceration is usually preceded by vaginal trauma caused by rape, coitus, obstetric instrumentation or the insertion of the foreign bodies. Additional risk factors for vaginal evisceration include previous vaginal surgeries and enteroceles [ 4 ]. In young patients, sexual intercourse before the complete healing of the vaginal cuff is considered as the main trigger event, while in elderly patients, evisceration is a spontaneous event [ 7 ].…”

“…Since the first report in 1864 by Hyernaux, 113 cases have been reported in medical literature [ 4 ]. Joy et al identified 12 cases of vaginal cuff evisceration resulting from coitus and 9 of these cases were post-vaginal hysterectomy [ 3 ].…”

Vaginal Evisceration of Small Bowel With Extraperitoneal Ileal Resection of the Herniated Loops: A Case Report

“…It is a rare condition but potentially a life-threatening emergency requiring emergency surgery to prevent morbidity as bowel perforation, necrosis, and secondary sepsis ( 2 ). Since the first report by Hyernaux in 1864 ( 3 ), just a few cases have been described in medical literature, and the exact incidence is still challenging to evaluate. A small number of isolated cases are presented with exposed bowel loops protruding through the vagina.…”