Vaginal Evisceration After Hysterectomy: A Literature Review

Abstract

The purpose of this review is to highlight the risk factors, clinical presentation, and different surgical management options for vaginal evisceration after vaginal, abdominal, or laparoscopic hysterectomy. We identified all reports of vaginal evisceration after these procedures using sources in the literature from 1900 to the present. We found that a total of 59 patients were reported, 37 (63%) had a prior vaginal hysterectomy, 19 (32%) had a prior abdominal hysterectomy (2 of which were radical hysterectomy), and 3 (5%) had a prior laparoscopic hysterectomy. The majority of these patients were postmenopausal women. Also, the precipitating event was most often sexual intercourse in premenopausal patients and increased intra-abdominal pressure in postmenopausal patients. In addition, the small bowel was the most common organ to eviscerate. Most of the patients presented with vaginal bleeding, pelvic pain, or a protruding mass. We conclude that vaginal evisceration after hysterectomy remains a rare event. It is more often seen after vaginal hysterectomy than after other types of hysterectomy. It can also occur spontaneously or following trauma or vaginal instrumentation, or any event that increases intra-abdominal pressure. Vaginal evisceration represents a surgical emergency, and the approach to therapy for it may be abdominal, vaginal or a combination of the two.

Small Bowel Evisceration Following Vaginal Hysterectomy is a General Surgical Emergency–A Case Report and Review of the Literature

“…The most common surgical precursor is the vaginal hysterectomy, which has been reported to account for over 60% of cases. Abdominal and laparoscopic hysterectomy may also contribute in approximately 30% and 5% of cases respectively [4]. Whilst vaginal evisceration is most common in the post-menopausal woman, it has been reported in the premenopausal lady who has had an abdominal hysterectomy, as a complication following coitus and posterior vaginal fornix rupture [5].…”

Vaginal evisceration after radical hysterectomy and adjuvant radiation

“…4 Indeed, there are only three cases of transvaginal evisceration after radical hysterectomy reported in the English literature.…”

Tubal prolapse after total laparoscopic hysterectomy

“…Thus, Fallopian tube prolapse has been variously associated with Filshie clip prolapse [11], ectopic and abdominal pregnancy [54,55], torsion [52], pneumoperitoneum (post-coital) [39], abscess and fistula [38]. Occasional cases of true evisceration have also been reported following hysterectomy [56][57][58]. Whilst inflammation has been reported on biopsy and histopathology, associated salpingitis has been noted far less commonly [10].…”