A Case of Transvaginal Evisceration

Cerqui, Anthony J.; Haran, Mano; Collier, Sheree M.

doi:10.1111/j.1479-828x.1998.tb03011.x

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…Changes in the anatomical position of the vagina due to surgery (disappearance of the ap valve mechanism of the vagina). Cerqui et al discussed this change in the anatomical position of the vagina, suggesting that it could be due to deviation from normal conditions in the maintenance of pelvic pressure distribution [17]. Under normal circumstances, the upper vaginal axis is parallel to the elevator plates and oriented perpendicular to the direction of abdominal pressure.…”

Section: Discussionmentioning

confidence: 99%

Investigation of risk factors for vaginal dehiscence and development of small bowel evisceration after robot-assisted radical cystectomy for female bladder cancer and an improved vaginal reconstruction technique to prevent its onset

Fukata,

Kawaguchi,

Yoshimura

et al. 2024

Preprint

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Introduction Transvaginal organ prolapse, such as small bowel evisceration, is a rare complication after radical cystectomy (RC) in female patients with invasive bladder cancer, However, it often requires emergency surgical repair. Here, we describe our experience with such a case and a review of similar previously reported cases, along with evaluation of the risk factors. We also propose a vaginal reconstruction technique to prevent this complication during robot-assisted laparoscopic radical cystectomy (RARC). Methods A total of 178 patients who underwent laparoscopic radical cystectomy (LRC) or RARC were enrolled, 34 of whom (19%) were female. One of the 34 female patients had transvaginal small bowel evisceration after RARC. We evaluated our case and six such previously reported cases, to determine vaginal reconstruction techniques during RARC to prevent this complication postoperatively. Results Median age of these cases was 73 (51-80) years, and all patients were postmenopausal. The median time to small bowel evisceration was 14 (6-120) weeks postoperatively. In addition, we changed the methods of the vaginal reconstruction technique during RARC from the conventional side-to-side closure technique to the improved caudal-to-cephalad closure technique. Since implementing this change, we have not experienced any cases of vaginal vault dehiscence or organ prolapse. ConclusionsTransvaginal small bowel evisceration after RC can easily become severe. Therefore, all possible preventive measures should be taken during RARC. We believe that our vaginal reconstruction techniques might reduce the risk of developing this complication.

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Section: Discussionmentioning

confidence: 99%

Investigation of risk factors for vaginal dehiscence and development of small bowel evisceration after robot-assisted radical cystectomy for female bladder cancer and an improved vaginal reconstruction technique to prevent its onset

Fukata,

Kawaguchi,

Yoshimura

et al. 2024

Preprint

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Pinto¹,

Hegde²,

Karekal³

et al. 2022

Cureus

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Spontaneous transvaginal small bowel evisceration is an extremely rare condition with a few more than 100 documented cases to date. The complications of such a rare entity revolve around its preoperative presentation as well as its operative and postoperative complications. The complications seen are intestinal incarcerations and perforations with an increased risk of post-surgical ileus and peritonitis in a timedependent fashion. In our case, a postmenopausal female presented with sudden onset bowel evisceration through a defect in the posterior vaginal apex during straining for defecation. Past medical history was significant for intermittent abdominal pain, bloating, and chronic constipation. The patient had no signs of trauma, signs of sexual assault, preceding events, or prior urinary disturbances. The patient was treated surgically with laparotomy and bowel-packing followed by Ward-Mayo's repair with added on anterior and posterior colporrhaphy, and site-specific repair. Postoperatively, following a period of prolonged ileus, the patient made a full recovery. This case report aims to provide a better understanding of the mechanism and occurrence of such an event and also intends to raise awareness of this rare presentation as an emergency condition requiring prompt surgical management.

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“…As a result, raised intra-abdominal pressure would now be directed at an axis parallel to the vaginal vault, thus making it vulnerable to rupture. [3]…”

Section: Discussionmentioning

confidence: 99%

“…Early recognition and urgent surgical intervention is imperative for adequate management, to lessen the associated morbidity and mortality and also to preserve the bowel viability. [2356] Emergency management of bowel evisceration consists of few vital elements which include stabilization of the patient, intravenous fluid replacement therapy, cleaning and packing the bowel with moist saline sponges, early prophylactic antibiotic cover for gastrointestinal flora, and immediate surgical repair and controlling hemorrhage with vaginal packs. [4]…”

Section: Discussionmentioning

confidence: 99%

“…[12] Bowel evisceration is more commonly seen (~68%) in postmenopausal older women. [123] Risk factors identified for evisceration include hypoestrogenism, coital or obstetric trauma, previous vaginal surgery, presence of enterocele and ageing. [2456] Previous gynecological surgeries, mainly hysterectomy and enterocele repair, were accountable in majority (73%) of patients diagnosed with transvaginal bowel evisceration.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous transvaginal bowel evisceration

Chhabra

Hegde

2013

Indian J Urol

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Transvaginal prolapse of bowel segments after major abdominal surgery is of rare occurrence and is commonly reported to follow after hysterectomy and enterocele repair. However, spontaneous bowel evisceration through vagina following cystectomy is even rare. We report and discuss a case of spontaneous transvaginal bowel evisceration in a postmenopausal woman with the intent of increasing its awareness among surgeons and proposing a precautionary measure for this entity.

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A Case of Transvaginal Evisceration

Abstract: We present a case of spontaneous evisceration of the small bowel through the vaginal vault in a 61-year-old women. The predisposing factors and management are discussed.

Cited by 5 publications

References 4 publications

Investigation of risk factors for vaginal dehiscence and development of small bowel evisceration after robot-assisted radical cystectomy for female bladder cancer and an improved vaginal reconstruction technique to prevent its onset

Investigation of risk factors for vaginal dehiscence and development of small bowel evisceration after robot-assisted radical cystectomy for female bladder cancer and an improved vaginal reconstruction technique to prevent its onset

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

Spontaneous transvaginal bowel evisceration

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