Transvaginal evisceration of small bowel

Toh, James Wei Tatt; Lee, Taina; Chiong, Corinna; Ctercteko, Grahame; Pathmanathan, Nim; Khoury, Toufic El; Wright, Donald J.; King, Jennifer

doi:10.1111/ans.14290

Cited by 4 publications

(8 citation statements)

References 7 publications

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“…When small-bowel evisceration develops, urgent surgery is necessary to prevent subsequent fatal outcomes. This may lead to bowel injury, necrosis, sepsis, and death (mortality up to 8%) [4] . Fifteen percent to 20% of these patients require bowel resection.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

Lee

Kim

et al. 2022

Medicine

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…When transvaginal evisceration occurs, urgent surgery is required, as it is a potentially life-threatening (up to 8% mortality) and distressing event [ 7 ]. It can eventually lead to gut injury, gangrene, gut resection, sepsis, and death [ 1 , 3 ]. The ileum is generally involved.…”

Section: Discussionmentioning

confidence: 99%

“…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 ]. Due to its rarity, the medical team can confuse it and fail to recognize it in time [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Negrete

Molina

Sanchez

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction and Importance Evisceration of the small bowel through the vagina is an extremely rare condition and a life-threatening surgical emergency. Complications associated with this condition include bowel ischemia, abdominal sepsis, and deep vein thrombosis. Therefore, prompt surgical consultation and treatment are crucial as delay in treatment can lead to a grim outcome. Case presentation We report the case of a 50-year-old female obese patient with a past medical history of uterine surgery. During a cough episode, she experienced sudden transvaginal evisceration that required emergent surgery. Thankfully she fully recovered and is doing well. Discussion and conclusions Transvaginal evisceration is a life-threatening and extremely rare pathology; it requires urgent diagnosis and surgical intervention since bowel viability can be compromised. During these rare events, interdisciplinary surgical cooperation is vital to obtain the best possible outcome for patients.

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Spontaneous transvaginal evisceration of small intestine in a case of long-standing uterine and rectal prolapse

Pattanaik,

Pattanaik

2024

BMJ Case Rep

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Spontaneous transvaginal small bowel evisceration, without recent trauma or surgery, is extremely rare. Complications include bowel obstruction, perforation, gangrene, septicaemia and death, requiring urgent surgical intervention. We report a case of a woman in her late 60s, who presented with 70–75 cm of small intestine eviscerated through the vagina, alongside a long history of uterine and rectal prolapse. Due to oedema in the intestine and mesentery, a vaginal reduction attempt failed. An emergency lower midline laparotomy was performed with a gynaecologist present. The eviscerated ileum was reduced, viability confirmed and repairs were made to the posterior vaginal vault defect and the peritoneal rent in the Douglas pouch. A Thiersch procedure was performed for the prolapsed rectum. Definitive surgery for the prolapsed uterus and rectum was deferred due to low condition. She recovered and was discharged on the 10th postoperative day but died from a myocardial infarction 3 months later.

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Transvaginal evisceration of small bowel

Cited by 4 publications

References 7 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

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

Spontaneous transvaginal evisceration of small intestine in a case of long-standing uterine and rectal prolapse

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