Coitus Induced Vaginal Evisceration Through Vaginal Cuff Dehiscence After Radical Hysterectomy - A Rare Case Report

Abstract

Vaginal evisceration of small bowel through vaginal cuff dehiscence after total abdominal hysterectomy is a rare complication in case of pre-menopausal women, which is sporadically mentioned in the literature. We have reported a case of small bowel evisceration through vaginal cuff dehiscence within two hours of first vaginal intercourse following 48 days of Radical hysterectomy which was indicative for grade III endometrial adenocarcinoma and then followed by 10 days' adjuvant chemotherapy. We escort the patient immediately to the tertiary center for multidisciplinary management. An emergency exploratory laparotomy was performed, and after reposition of the small bowel, the vaginal vault was repaired with interrupted sutures using Vicryl-1. The patient was discharged on 9th post-operative day in good condition. As because the post-coital vaginal evisceration through vaginal cuff dehiscence is a modifiable risk factor, we are highlighting on the counseling to avoid early coitus after hysterectomy especially in case of patients with endometrial carcinoma and on adjuvant chemotherapy. In such case, early coitus may arise potential life threatening surgical emergency. So, we suggest arranging appropriate counseling for the patient and her spouse, after gynaecological oncology surgery to resume their coital activity minimum after 8-12 weeks' post-surgery.

Small Bowel Evisceration after Spontaneous Vaginal Cuff Rupture

“…Rates are hard to determine due to the rarity, but literature shows a rate of between 0.032 and 1.2% of hysterectomies. Mortality increases with small bowel evisceration [1].…”