Uterine Rupture with Evisceration of Intestines through the Vagina during Labour

Abstract

Uterine rupture is a life threatening obstetric emergency and is associated with high maternal and perinatal mortality. There are some risk factors associated with uterine rupture which may include: prolonged obstructed labour, previous scarred uterus, grand-multiparity, macrosomic baby, abnormal lie, instrumental delivery, induction of labour, oxytocin stimulation and excessive uterine manipulation. Its modes of presentation have been widely reported. Here, we present a case with an unusual mode of presentation where about two-third of the small intestines protruded through the vagina following some manipulations by an unskilled birth attendant. This highlights the fact that when uterine rupture is suspected, the cord-like structure protruding per vaginum may not always be umbilical cord.

Spontaneous Transvaginal Small Bowel Evisceration With Uterine Procidentia: A Report of a Rare Case

“…Spontaneous transvaginal bowel evisceration is a rare emergency surgical condition, with the at-risk groups including the elderly (postmenopausal) and premenopausal females with a prior positive surgical history [ 5 , 9 ]. In the premenopausal population, following hysteroscopic or vault surgeries, defects in fascia repair could be a lead point for evisceration of abdominal contents [ 4 , 10 ]. This mechanism of evisceration was first described in the 19th century through a rent in the vaginal wall leading to the prolapse of the abdominal contents [ 1 , 3 ].…”

Primeiro registro de eversão vaginal em Psammobatis rutrum Jordan, 1891 (Rajiformes: Arhynchobatidae)

“…Outro fator responsável por este quadro pode estar associado a dificuldades durante o parto/ ovoposição (distocia), como observado para diferentes grupos zoológicos, incluindo peixes (Wildgoose, 2000;Asiimwe et al, 2014;Gal, Baska, Farkas, Mándoki, & Szabó, 2014;Manjunatha, Girish & Narayanaswamy, 2016;Staggs, 2016;Van Zeeland, 2016;Chaudhari et al, 2018;Leite, Wosnick, Giareta & Freire, 2020). Assim, no presente estudo também podemos considerar que a eversão da parede vaginal pode ter sido resultante de um processo de prolapso pélvico intensificado por um evento de cópula malsucedido, postura repentina de ovos devido ao estresse, ou ainda à distocia, geralmente relacionada ao tamanho e posicionamento anormal de ovos/ embriões ou a problemas de contração abdominais (Noakes, Parkinson, England & Arthur, 2001;Henningsen, Smale, Garner & Kinnunen, 2004;Eid-Arimoku & Trompetas, 2011;George et al, 2017;Wosnick, Adams & Freire 2018;Wosnick et al, 2019;Akpan, Akpanika, Nwagbara, Asibong, & Etuk 2019;Leite et al, 2020).…”