Transvaginal Evisceration of the Small Bowel More Than 15 Years After Abdominal Hysterectomy and Vaginal Surgery

Abstract

Transvaginal evisceration of the intra-abdominal organs is a rare emergency event. In this paper, we discuss the case of a 97-year-old female who presented to the emergency department due to abdominal pain and a large prolapse with visible extrusion of the small bowel per vagina. Past surgical history was significant for a total abdominal hysterectomy and surgical repair for pelvic organ prolapse; both performed more than 15 years prior to the patient's current presentation. The eviscerated bowel was initially reduced through a vaginal vault defect into the abdominal cavity. A lower midline laparotomy was undertaken for further assessment, and the vault defect was closed by transabdominal repair with no evident compromise to bowel function. We suggest that a multidisciplinary approach to prompt examination and management by gynaecology and general surgery is vital in reducing the risk of morbidity and mortality.

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

“…The patients commonly present with pelvic or lower abdominal discomfort, vaginal pain, bleeding, and feeling of fullness. Only sometimes they show obvious protruding viscera from the vagina ( 16 , 17 ), as in our case report. As described by Ramirez et al, almost all presentations are subtle, with no specific symptoms and no clear evidence that can justify the suspect of an evisceration ( 9 ).…”

Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse

“…Many other factors can influence this condition, such as lifestyle, hypothyroidism, obesity, multiparous women, previous pelvic radiotherapy, and poor collagen structure [ 1 – 10 ]. However, most case reports on the topic described a trigger moment for the evisceration as recent trauma or surgery, coughing, constipation or any other factor that would increase the intra-abdominal pressure suddenly in the context of pelvic floor weakness [ 8 , 16 , 18 , 19 ]. In premenopausal women, transvaginal intestinal evisceration is extremely rare and often associated with instrumentation, obstetric injury or coital trauma, which vaginal lacerations may accompany [ 7 , 10 , 14 , 20 ].…”

“…This, however, limits thorough inspection of the bowel length [ 19 ]. So, in these cases, a combined laparoscopic and vaginal approach may be beneficial to enable appropriate inspection of the abdominopelvic viscera before repairing the vaginal defect [ 8 , 19 ]. However, in most cases such as ours, the intraperitoneal reposition of the eviscerated intestine was not possible (due to the status of the affected loops or the vaginal defect is located too high) [ 19 ].…”

“…Transvaginal intestinal evisceration is a rare surgical emergency with potentially fatal consequences [ 1 – 6 ]. A limited number of cases has been published in the literature, so the exact incidence is difficult to determine [ 7 , 8 ]. Aetiology is also unclear and multifactoral [ 7 , 8 ].…”

“…A limited number of cases has been published in the literature, so the exact incidence is difficult to determine [ 7 , 8 ]. Aetiology is also unclear and multifactoral [ 7 , 8 ]. The usual clinical presentation includes small bowel obstruction due to a herniation of the intestines through the vagina.…”