Massive intestinal prolapse through the vagina (enterocele)

Abstract

We present the case of an 83-year old female patient with a 3-day history of an obvious vaginal bulge. The patient's medical history was important only for psychotic disorder and uterine prolapse, which the patient habitually reduced with her hands. Physical examination revealed prolapse of the small intestine (measuring 1 m in length) through vagina without peritoneal coverage. During surgery, a breach was recognized in the peritoneum as well as a defect in the right lateral vaginal wall, through which both cecum and small intestine prolapsed. Having determined small intestinal viability intraoperatively, the enterocele was reduced and the peritoneal breach was closed with a continuous running suture and a mesh. The vaginal defect was corrected by sutures and the repair was augmented by mesh. Finally, a pessary was placed inside the patient's vagina. The postoperative course was uneventful and the patient was discharged six days later. Bergstrom JO, Colling JC, Clark AL: Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501-6. 4. Hsu Y, Chen L, Delancey JO, Ashton-Miller JA: Vaginal thickness, cross-sectional area, and perimeter in women with and those without prolapse. Obstet Gynecol. 2005;105(5 Pt 1):1012-7. 5. Virtanen HS, Ekholm E, Kiilholma PJA. Evisceration after enterocele repair: a rare complication of vaginal surgery. Int Urogynecol J 1996;7:344-347 6. Dawlatly B, Lavie O, Lopes A.Transvaginal evisceration of small bowel after radical hysterectomy and pelvic lymphadenectomy. Gynecol Oncol 1999;73:165-166 7. Cardosi RJ, Hoffman MS, Roberts WS, Spellacy WN. Vaginal evisceration after hysterectomy in premenopausal women. Obstet Gynecol 1999; 94:859 8. Ferrera PC, Thibodeau LG. Vaginal evisceration. J Emerg Med 1999; 17:665-667 9. Moore RD, Miklos JR. Repair of a vaginal evisceration following colpocleisis utilizing an allogenic dermal graft. Int Urogynecol J 2001:12:215-217 10. Nezhat CH, Nezhat F, Seidman DS, Nezhat C. Vaginal vault evisceration after total laparoscopic hysterectomy. Obstet Gynecol 1996;87:868-870 11. Powell JL, Gentry JK. Vaginal evisceration. J Pelv Surg 2001;7:94-97 12. Joy SD, Phelan M, McNeill HW. Postcoital vaginal cuffrupture 10 months after a total vaginal hysterectomy. J Reprod Med 2002;47:238-240 13. M. D. Moen, M. Desai, R. Sulkowski. Vaginal evisceration managed by transvaginal bowel resection and vaginal repair. Int Urogynecol