V-035 Transvaginal Evisceration, Laparoscopic Approach

Abstract

Aim We present the laparoscopic approach of a case of transvaginal evisceration after hysterectomy. Material & Methods 50 yo Female, with a history of bilateral ovaric and endometrial endometroid carcinoma, for which bilateral laparoscopic anexectomy and subsequent hysterectomy and cytoreduction surgery were performed two months earlier. She consulted to emergency department for metrorrhagia and abdominal discomfort of one week's evolution. Physical examination revealed a dehisced vaginal vault with evisceration of small bowel loops. Abdominal CT scan was performed in which other intra-abdominal complications were ruled out. Urgent surgical intervention was decided and a minimally invasive approach was proposed. During the operation, dehiscence of the vaginal vault was observed without other findings. The separated edges are refreshed and a running suture is performed with a barbed suture. As reinforcement, a titanized polypropylene mesh was placed and fixed with cyanoacrylate. Results The patient was discharged on the 2nd postoperative day without incident. Conclusions Transvaginal evisceration is a rare complication that usually occurs after hysterectomies. If it is not possible to reduce the contents, it can cause suffering of the herniated structures. The treatment consists of closing the defect and acting on the complications it may cause. The minimally invasive approach provides the already known benefits for the patient and a better vision and surgical field for the surgeon.