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

Abstract

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.

Atraumatic Spontaneous Transvaginal Small Bowel Evisceration: A Rare Surgical Emergency

“…Around 75% of patients who present with it have a previous history of gynecologic surgery such as hysterectomy or vaginal prolapse repair [7]. The primary cause of transvaginal evisceration is typically attributed to the dehiscence of the vaginal vault, characterized by the rupture of the vaginal edges and the adjacent peritoneum [8], where evisceration may or may not occur. Transvaginal evisceration occurs more frequently in postmenopausal women, accounting for 70% of cases.…”