Experience in the Management of Vaginal Cuff Dehiscence and Evisceration: A Retrospective 37-Year Single-Center Study

Abstract

PurposeVaginal cuff dehiscence (and evisceration) (VCD(E)) is an extremely rare and late-onset complication of total hysterectomy (TH). Limited evidence is available to guide clinicians in managing VCD(E). This study aimed to summarize the clinical characteristics of patients with VCD(E) treated in our center and share our experience in managing VCD(E).Patients and methodsFrom 1983 to 2020, a total of 14 cases of VCD(E), including 10 cases in our hospital and 4 cases in other hospitals, were included. Medical records were reviewed to summarize the clinical features and management of VCD(E).ResultsThe incidence of VCD(E) in our hospital was 10/46,993 (0.02%), and all 10 patients underwent laparoscopic hysterectomy. The median TH-to-VCD(E) interval was 3.13 months (8 days–27.43 months), and 11/14 (78.57%) patients experienced VCD(E) after coitus. The 3 major symptoms included abdominal pain in 11 patients, irregular vaginal bleeding in 8, and sensation of bulging or prolapsed organs in 4. Except for 2, most patients presented to our hospital within 72 h since the onset of the discomfort. All 14 cases were diagnosed through speculum examination: 3 had simple VCD, and 11 had VCDE. The protruding bowels of 4 patients were immediately manually repositioned in the emergency department without anesthesia. Regarding the surgical approach, 11 patients underwent simple transvaginal, 2 patients underwent laparoscopic-vaginal combined (transvaginal cuff closures), and 1 patient underwent laparoscopic. All but 1 patient did not undergo resection of the eviscerated organs. The median follow-up period was 39.33 (7.9–159.33) months. No patients showed any evidence of recurrence to date.ConclusionsLaparoscopic hysterectomy is a risk factor for VCD(E), and early initiation of sexual intercourse is the most common trigger of VCD(E). Clinicians should educate patients to postpone sexual intercourse for at least 3–6 months after TH. Immediate medical attention and patient-specific surgical management are crucial to avoid serious complications.

Application of a Malecot drain in the management of a vaginal cuff dehiscence: A case report and review of the literature

“…These approaches may include open abdominal, vaginal, or laparoscopic surgery versus secondary intention ( Cronin et al, 2012 ). Expectant management is reserved for partial VCDs with openings less than 1 cm ( Eoh et al, 2023 , Boersen et al, 2019 , Ma et al, 2022 ). Other approaches depend on patient stability, surgeon experience, suspicion or presence of intra abdominal organ damage, or presence of bowel evisceration ( Cronin et al, 2012 ).…”

“…In cases of superimposed infection, it is particularly reasonable to consider utilizing a pelvic drain as one would for management of other pelvic and abdominal infections. Further utility is suggested for patients presenting with heavy vaginal discharge ( Ma et al, 2022 ). These decisions depend on provider experience, institutional practice norms, and patient characteristics to determine the optimal approach to promote healing.…”

Coitus induced colpo evisceration in a 3-months post hysterectomy patient: an unusual tale in gynecology

“…9 cases were operated due to malignancies, 10 cases coitus was the triggering cause, most case occur at a medium of 41 postoperative days and 3 had a recurrent dehiscence needing a second repair, on this series the used a vaginal approach and sometimes combined vaginal and laparoscopic approach. 6 Hormonal alterations together with atrophies at the level of the female genital apparatus represent a risk factor in the postmenopausal period. Up to 70% of patients with evisceration have some serious associated condition, such as chronic obstructive pulmonary disease, diabetes mellitus, cancer, infectious processes, or alterations in nutritional status (obesity, thinness, and deficiency states, among others).…”

Vaginal Cuff Dehiscence: Two Case Reports and a Review of the Literature

“…The reported rates of VCD varied between 0.02% [ 4 ] and 4.2% [ 5 ], with other studies falling within this range [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Some studies focused on specific hysterectomy types, providing incidence ranges for each surgical approach, as shown in Table 1 .…”