Small Bowel Evisceration through the Vaginal Vault: A Rare Surgical Emergency

Abstract

Small bowel evisceration through the vagina is a rare surgical emergency that requires urgent surgical intervention because of the risk of developing acute small bowel ischemia. We present a case of a 91 year old female presenting with acute small bowel evisceration with majority of her small bowel visible outside the vagina. The bowel wall was edematous requiring emergent laparotomy and reduction of bowel with repair of the vaginal vault. The patient did not require bowel resection. Transvaginal small bowel evisceration is uncommonly described in the literature. Rare cases are reported in elderly, post-menopausal women who have undergone hysterectomy. Multiple approaches to surgical management including laparoscopic, open abdominal, transvaginal as well as combined approaches have been described. Perineal herniation must be kept in the differential in elderly post-hysterectomy patients with sudden onset of abdominal pain with urgent surgical intervention advised.

Transvaginal evisceration of the small bowel a rare and potentially lethal event, a case report

“…Transvaginal intestinal prolapse is a rare and potentially lethal surgical condition [ 1 ]. Since the first report by Hypernaux et al, in 1864, fewer than 150 cases have been published in the English Literature [ 1 , 2 ]. It is a unique surgical emergency that usually appears on postmenopausal women (70%) or women who had previous vaginal or uterine surgery (63%), which creates decreased vascularization and vaginal wall atrophy [ 2 , 3 ].…”

“…Since the first report by Hypernaux et al, in 1864, fewer than 150 cases have been published in the English Literature [ 1 , 2 ]. It is a unique surgical emergency that usually appears on postmenopausal women (70%) or women who had previous vaginal or uterine surgery (63%), which creates decreased vascularization and vaginal wall atrophy [ 2 , 3 ]. Pre-menopausal women can also be affected; however, it's rarer and tends to be associated with vaginal trauma or sexual activity [ 4 ].…”

“…Most risk factors are associated with weakening the abdominal and vaginal wall, including older age, vaginal and perineal surgery (especially hysterectomy), obesity, increased intraabdominal pressure, constipation, cough, and radiotherapy [ 1 , 2 , 5 ]. As it was found in our patient.…”

“…The evisceration of the small intestine through the vagina is an uncommon event [ 1 , 2 ]. However, it can turn quickly into a fatal one since complications can become deadly if there is a delay in treatment [ 3 ].…”

“…However, it can turn quickly into a fatal one since complications can become deadly if there is a delay in treatment [ 3 ]. Due to its rarity, the medical team can confuse it and fail to recognize it in time [ 2 , 3 ]. Time is essential in this pathology; therefore, the medical team must be prepared to face such a critical event [ 1 , 4 ].…”