Small Bowel Evisceration after Spontaneous Vaginal Cuff Rupture

McMaster, Brian C; Molins, Caroline

doi:10.7759/cureus.5535

Cited by 6 publications

(8 citation statements)

References 4 publications

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“…Such a change may result in the vagina losing its valve-like structure. [ 14 ] In this case, a distended bladder was observed on the computed tomography. This could be a chronic complication of radical hysterectomy for cervical cancer and might have interfered with spontaneous reduction of the prolapsed bowel.…”

Section: Discussionmentioning

confidence: 79%

Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer

Lee

Kim

et al. 2022

Medicine

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Rationale: Transvaginal evisceration of the small bowel is an extremely rare condition after hysterectomy, which requires urgent surgical intervention to prevent serious bowel morbidity and mortality. Patient concerns: A 65-year-old woman presented with sudden-onset severe abdominal pain and a mass protruding through the vagina. The past surgical history was significant, with an abdominal hysterectomy for cervical cancer performed 11 weeks prior to presentation. Diagnosis: Pelvic examination revealed prolapsed small-bowel loops (18-20 cm in length). Pelvic computed tomography scan confirmed the presence of transvaginal evisceration of the small bowel. Interventions: Bowel reduction and urgent laparotomy were the selected treatment approaches for a detailed inspection and thorough washing of the intrα-abdominal cavity. A Foley catheter was inserted in the emergency room, with the subject in the lithotomy position. The prolapsed bowel loops spontaneously reduced without manual reduction, and the vault defect was repaired transvaginally. Outcomes: The patient experienced no postoperative complications and remained disease-free for 9months postoperatively. Lessons: Transvaginal evisceration of the small bowel should be considered a surgical emergency. A multidisciplinary approach to prompt case management involving clinicians in gynecology, general surgery, and emergency medicine is vital for preventing serious consequences. Hysterectomy is the most frequently performed gynecological surgical procedure, and evisceration occurs most often after hysterectomy. Therefore, patients should be informed about this rare but possible hysterectomy complication.

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Section: Discussionmentioning

confidence: 79%

Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer

Lee

Kim

et al. 2022

Medicine

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“…This increased incidence could be explained by vaginal wall atrophy, which coincided with the triad of hypoestrogenism, chronic tissue devascularization, and pelvic floor weakness [ 10 , 15 ]. Most patients with transvaginal evisceration have previous gynaecological surgery or concomitant pelvic organ prolapse [ 10 , 15 , 16 ]. According to a review of all hysterectomies and pelvic repairs performed at Mayo Clinic from 1970 through 2001, Croak et al reported a 0.032% incidence of vaginal evisceration after a pelvic operation [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many other factors can influence this condition, such as lifestyle, hypothyroidism, obesity, multiparous women, previous pelvic radiotherapy, and poor collagen structure [ 1 – 10 ]. However, most case reports on the topic described a trigger moment for the evisceration as recent trauma or surgery, coughing, constipation or any other factor that would increase the intra-abdominal pressure suddenly in the context of pelvic floor weakness [ 8 , 16 , 18 , 19 ]. In premenopausal women, transvaginal intestinal evisceration is extremely rare and often associated with instrumentation, obstetric injury or coital trauma, which vaginal lacerations may accompany [ 7 , 10 , 14 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse

Arabadzhieva

Shavalov

et al. 2022

BMC Surg

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Background Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral. Case presentation We report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness. Conclusions Early detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team.

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“…These findings are consistent with our patient's presentation. Complications from transvaginal bowel herniation include bowel strangulation, bowel incarceration leading to ischemia, bowel perforation, intra-abdominal sepsis, peritonitis, septicemia, ileus, and deep vein thrombosis [ 1 , 2 , 5 ]. Diagnosis of evisceration is done by direct visualization during pelvic examination.…”

Section: Discussionmentioning

confidence: 99%

“…Transvaginal small bowel evisceration is a rare complication following a hysterectomy that is associated with advance age, enterocele, and previous vaginal surgery. “Rates are hard to determine due to the rarity, but literatures shows a rate between 0.032% and 1.25” [ 2 ]. The overall mortality rate is reported as 5.6 percent; however, when the bowel is strangulated through the vagina, the defect morbidity is higher [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Case of Transvaginal Small Bowel Evisceration following Hysterectomy with Discussion of Emergency Department Diagnosis and Management

Apicella

Mayrink

Rajadhyaksha

et al. 2022

Case Reports in Emergency Medicine

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Transvaginal small bowel evisceration is a rare surgical emergency that requires urgent surgery to prevent bowel necrosis, sepsis, and death. It was first reported in 1864 by Hyernaux with less than 100 cases reported since the original publication. The overall mortality rate is reported as 5.6 percent. We present the case of a 49-year-old woman who presented to the emergency department with a chief complaint of moderate abdominal pain and vaginal bleeding for 1 hour. The patient reported that she underwent a robotic-assisted laparoscopic hysterectomy 11 weeks prior for uterine fibroids. Visual examination revealed a loop of the small bowel coming from the superior aspect of her vagina. Literature reviews have noted a higher incidence of dehiscence following robotic-assisted total laparoscopic hysterectomy. It is important for the emergency physician to make the diagnosis, initiate prompt consultation with departments of obstetrics and gynecology and general surgery, and treat for potential infection.

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Small Bowel Evisceration after Spontaneous Vaginal Cuff Rupture

Cited by 6 publications

References 4 publications

Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer

Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer

Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse

A Case of Transvaginal Small Bowel Evisceration following Hysterectomy with Discussion of Emergency Department Diagnosis and Management

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