Transvaginal evisceration after radical abdominal hysterectomy

BACKGROUND: Intestinal evisceration through the vagina is rare and transvaginal evisceration after transabdominal surgery is far more rare. CASE: We present an unusual case of a postmenopausal woman who presented with transvaginal evisceration of the small bowel after radical abdominal hysterectomy and pelvic lymphadenectomy. CONCLUSION: This was a rare case of terminal ileal evisceration through a ruptured vaginal cuff after radical hysterectomy and bilateral pelvic lymphadenectomy. We performed a delayed closure of the vaginal defect through the vagina after manual reduction of the eviscerated small bowel, and the outcome was satisfactory.     

Vaginal evisceration after hysterectomy: the repair by a laparoscopic and vaginal approach with a omental flap

BACKGROUND: Vaginal evisceration is generally repaired by vaginal or abdominal route. We describe two cases of vaginal evisceration using a combined laparoscopic and vaginal approach employing an omental flap. CASES: Case 1: A radical abdominal hysterectomy was performed in a premenopausal patient for a FIGO IB1 cervical cancer. Four months later, she was found to have a vaginal cuff dehiscence which was repaired by a vaginal approach. Two months later, she had a vaginal cuff evisceration which was repaired using a combined laparoscopic and vaginal approach employing an omental flap with good success. Case 2: A postmenopausal woman who underwent an abdominal hysterectomy and pelvic lymphadenectomy for a FIGO IB endometrial cancer was noted to have a vaginal evisceration two months after primary surgery. This was also successfully repaired using a combined laparoscopic and vaginal approach employing an omental flap. CONCLUSION: The combined laparoscopic and vaginal approach with omental flap is effective for repair of a vaginal cuff dehiscence with bowel evisceration. The addition of laparoscopy provides an opportunity for inspection of the small bowel, the peritoneal toilet, and mobilization of an omental flap.     

Postcoital vaginal cuff rupture 10 months after a total vaginal hysterectomy. A case report

BACKGROUND: Transvaginal evisceration following total vaginal hysterectomy secondary to coitus is extremely rare. CASE: A woman presented 10 months following a total vaginal hysterectomy with complaints of progressive postcoital abdominal and shoulder pain as well as a pinkish vaginal discharge. Examination revealed a 3-cm defect at the left edge of the vaginal cuff. Corrective surgery followed overnight observation with pain management. CONCLUSION: Postcoital vaginal cuff disruption is rare, and complications can range from bowel evisceration to hemorrhage. Management should be tailored to the severity of the complications.     

Small bowel and omentum evisceration after abdominal hysterectomy

Intestinal evisceration through the vagina is rare, and transvaginal evisceration after transabdominal surgery is even more rare. Vaginal evisceration is a very rare complication of abdominal hysterectomy, but when this occurs, it is a surgical emergency. Prompt attention is required to prevent further morbidity and potential mortality. The most common organ to eviscerate is the distal ileum, with only two cases of prolapsed omentum having been reported. We present an unusual case of a postmenopausal woman who presented with a vaginal evisceration of the small bowel and omentum after abdominal hysterectomy.     

Transvaginal evisceration after hysterectomy: Is vaginal cuff closure associated with a reduced risk?

OBJECTIVE: To evaluate the overall incidence of transvaginal evisceration following hysterectomy and to assess the risk associated with indication, route of surgery, age and vaginal cuff closure technique. MATERIALS AND METHODS: A database was used to identify all patients undergoing hysterectomy from 1995 to 2001 at our institution and all the patients admitted for vaginal evisceration during the same period. Each vaginal evisceration was analyzed for time of onset, trigger event, presenting symptoms, details of prolapsed organs and type of repair surgery. RESULTS: Of the 3593 patients enrolled in the study, 63.5% underwent abdominal hysterectomy, 33.0% vaginal hysterectomy, and 3.5% laparoscopic hysterectomy. Ten patients (0.28%) presented to the emergency room with vaginal evisceration. No statistical differences in evisceration rates were seen according to the route of surgery. No differences were found between the 1440 patients who had closure of the vaginal cuff and the 2153 who had an unclosed cuff closure technique. CONCLUSIONS: Our data suggest that, in young patients, sexual intercourse is to be considered the main trigger event before the complete healing of the vaginal cuff while, in elderly patients, the evisceration is a spontaneous event. Uterine prolapse was not associated with a higher rate and the route of surgery or vaginal cuff closure technique did not influence the dehiscence rate.     

Posthysterectomy intestinal prolapse after coitus and vaginal repair

Introduction Transvaginal bowel evisceration following either vaginal or abdominal gynecologic operations is a very rare complication. Furthermore, vaginal cuff rupture with the prolapse of the small bowel through the vagina during sexual intercourse after abdominal hysterectomy in a premenopausal woman is even more rare. However, regardless of the etiology, transvaginal evisceration requires prompt recognition and surgical intervention.Case report Here, we report a premenopausal woman who developed transvaginal bowel evisceration during the first postoperative intercourse.     

Vaginal evisceration after hysterectomy: a literature review

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.     

Laparoscopic management of vaginal evisceration: case report and review of the literature

Vaginal evisceration is a rare condition that presents with protruding mass, vaginal bleeding, and pelvic pain. Vaginal evisceration is most commonly associated with previous vaginal surgery but may occur spontaneously, and represents a surgical emergency. We report a case of vaginal evisceration in a 42-year-old premenopausal woman 6 months after hysterectomy. This case shows the value of laparoscopy in management of vaginal evisceration.     

Evisceración intestinal tardía a través de la vagina tras histerectomía

Intestinal evisceration through the vagina is a rare complication of hysterectomy but constitutes an emergency. Both the pathogenesis and prevention of this event are controversial. The average time of onset is 128 days. We report the case of a patient, with onset at 390 days. Surgical treatment was performed by laparotomy with bowel resection and closure of the vaginal vault.     

Characteristics of patients with vaginal rupture and evisceration

OBJECTIVE: To characterize vaginal rupture and evisceration. METHODS: We reviewed medical records (1970-2001) for use of the diagnostic terms "vaginal rupture," "vaginal evisceration," and "ruptured enterocele." RESULTS: Twelve clinical cases were identified. Patients usually presented with pain, vaginal bleeding, and abdominal pressure. In 9 of 12 women, rupture was primarily associated with postmenopausal prolapse and a history of pelvic surgery. Women with a history of abdominal hysterectomy tended to rupture through the vaginal cuff, and those with a history of vaginal hysterectomy tended to rupture through a posterior enterocele. Premenopausal rupture in 1 woman occurred postcoitally and involved the posterior fornix. Prolapse recurrence after repair was limited to 1 woman. CONCLUSIONS: Vaginal rupture and evisceration should be considered in women presenting with acute vaginal bleeding and pelvic pain. Evaluation is especially important in postmenopausal women with a history of pelvic surgery. In some cases, surveillance after pelvic surgery may prevent rupture, evisceration, and incarceration. LEVEL OF EVIDENCE: II-3     

Evisceration 5 years post abdominal hysterectomy

This report describes a case of a 55-year old woman presenting with evisceration of small bowel through the vagina, five years after a Total abdominal hysterectomy and bilateral salpingoopherectomy for irregular bleeding and a benign ovarian cyst. Examination under anesthesia revealed a 70 cm loop of bowel prolapsing through a 5 cm defect in the vaginal vault. She underwent an exploratory laparotomy and repair of vaginal vault defect. Small bowel prolapse through vaginal vault defect is a rare complication after abdominal hysterectomy. Appropriate management includes prompt recognition, thorough assessment of the herniated viscus and surgical repair of the vaginal defect. Combining abdominal and vaginal approaches as in our case may facilitate repair and avoid further morbidity.     

Vaginal evisceration during intraperitoneal chemotherapy for advanced ovarian cancer

BACKGROUND: Recent studies have established that intraperitoneal chemotherapy is associated with improved outcomes compared with intravenous treatment in patients with advanced, optimally cytoreduced ovarian cancer, but at the expense of increased toxicity. We present a case of vaginal evisceration during intraperitoneal chemotherapy for advanced ovarian cancer. CASE: Following an optimal cytoreduction including total hysterectomy for advanced ovarian cancer, a 63-year-old woman underwent intraperitoneal chemotherapy. On pelvic examination prior to her second cycle of chemotherapy, she was found to have vaginal evisceration of small bowel. CONCLUSION: Intraperitoneal chemotherapy imparts an improved survival, but at the expense of increased toxicity. It is possible that the increased abdominal pressure during intraperitoneal chemotherapy contributes to the risk for vaginal evisceration. In patients planning on undergoing intraperitoneal chemotherapy, supracervical hysterectomy should be considered in appropriate candidates.     

Vaginal evisceration after hysterectomy: a rare condition a gynecologist should be familiar with

Purpose  To report a case of vaginal vault rupture with intestinal herniation per vagina after hysterectomy and highlight the risk factors, clinical presentation and treatment options of this rare gynecologic emergency. Methods  A 70-year-old woman presented to the emergency department with vaginal evisceration, emerged 4 years after vaginal hysterectomy for uterine prolapse. Approximately 30 cm of the terminal ileum was irreducibly protruding through the vagina. Results  The patient was transferred to the operating theatre. The prolapsed bowel was reduced via the combined vaginal-abdominal route and the vaginal cuff was closed with non-absorbable interrupted sutures. Conclusion  Awareness as well as high suspicion index among gynecologists and all involved care givers, is important for early diagnosis, given that vaginal evisceration is a potentially life-threatening condition necessitating prompt surgical intervention.     

Vaginal herniation: case report and review of the literature

OBJECTIVE: The purpose of this study was to discuss the treatment of a case of spontaneous intestinal herniation per vagina in a patient who had undergone previous transabdominal hysterectomy and to review the related literature. STUDY DESIGN: A computer-based search of the English literature from January 1900 to October 2004 with the use of the terms vaginal herniation, vaginal evisceration, and vaginal trauma/injury was performed. Causes, presentation, and treatment were discussed and compared with a recent case that was treated locally in our hospital. RESULTS: Vaginal evisceration was described in the literature as early as 1864; since then <100 cases have been reported in the literature. It is more common in menopausal women with previous hysterectomy pelvic or vaginal surgery. Vaginal trauma, as in rough coitus, instrumentation, obstetric injury, is a recognized cause in premenopausal women. CONCLUSION: Vaginal evisceration is a rare, distressing emergency that requires aggressive resuscitation and urgent surgical intervention.     

Evisceration occurred 1 year after vaginal vault repair for relapsed pelvic organ prolapse

This report describes the case of an 81-year-old woman with sudden evisceration of the small intestine through the vagina. It occurred one year after repair of a vaginal vault prolapse, which was initially treated by vaginal hysterectomy and colporrhaphy three years prior to the repair. On examination, we found a 70-80-cm loop of bowel prolapsing through a 3-cm oval defect in the vaginal vault. The patient underwent emergency exploratory laparotomy under general anesthesia. After careful reduction of the eviscerated small intestine, the hernia hiatus was closed and the widened cul-de-sac was obliterated by performing a Moschcowitz culdoplasty. Rapid intervention by abdominovaginal surgery may enable smooth repositioning of the eviscerated intestine, thus preventing subsequent morbidity.     

Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study

Objective

This study estimates the incidence of vaginal cuff dehiscence resulting from different approaches to hysterectomy.

Study design

This multicentric study was carried out retrospectively. We retrospectively analyzed 8635 patients; 37% underwent abdominal hysterectomy, 31.2% vaginal hysterectomy, and 31.8% laparoscopic hysterectomy. All the hysterectomies were considered, vaginal evisceration was registered and analyzed for time of onset, trigger event, presenting symptoms, details of prolapsed organs and type of repair surgery. Continuous variables were compared using the one-way analysis of variance between groups as all data followed a Gaussian distribution, as confirmed by the Kolmogorov–Smirnov test. Differences among subgroups were assessed using the Tukey–Kramer multiple comparisons test. Categorical variables were compared with two tailed Chi-square tests with Yates correction or Fisher's exact test, as appropriate. Pearson's linear correlation was used to verify linear relationships between the dehiscence interval and patient's age at surgery.

Results

Thirty-four patients (0.39%) experienced vaginal evisceration. The laparoscopic route was associated with a significantly higher incidence of dehiscence (p < 0.05). No differences were found between the 6027 patients (69.8%) who had closure of the vaginal cuff and the 2608 (30.2%) who had an unclosed cuff closure technique.

Conclusion

Vaginal evisceration after hysterectomy is a rare gynecological surgical complication. Sexual intercourse before the complete healing of the vaginal cuff is the main trigger event in young patients, while evisceration presents as a spontaneous event in elderly patients. Surgical repair can be performed either vaginally or laparoscopically with similar outcomes.     

Vaginal evisceration. Apropos of a case

The authors report one observation of vaginal evisceration of the small intestine which occurred one year after vaginal hysterectomy for uterine prolapse. A review of the literature shows the rarity of these cases. The treatment is surgery.     

Vaginal evisceration after trauma unrelated to previous pelvic surgery

Background  Vaginal evisceration is described as extrusion of intraperitoneal contents secondary to the disruption of the vagina. It is an extremely rare emergency condition. Objectives  To describe a very rare case of vaginal evisceration that occurred after blunt trauma in a patient with no prior pelvic surgery. Case report  This report describes vaginal evisceration in a 73-year-old female with no prior pelvic surgery, after blunt trauma. The patient was handled by the cooperation of gynecology and general surgery departments. An immediate surgery was performed after stabilization of the patient and no postoperative complications occurred. Conclusion  Whatever be the treatment approach, emergency management of vaginal evisceration is critical to the preservation of a viable bowel. Repositioning of viable bowels into the abdominal cavity and appropriate surgical repair are cornerstones of the treatment.     

Evisceración vaginal. Abordaje abdominal y reparación con malla sintética

Spontaneous vaginal evisceration is a rare phenomenon in daily clinical practice. Since McGregor reported the first case at the beginning of the past century, more than 70 cases have been reported to date. Spontaneous vaginal evisceration usually occurs in patients with postmenopausal hypoestrogenism associated with previous gynecologic surgery. This entity has recently been described in non-gynecological conditions after perineal proctectomy. We present a new case of spontaneous vaginal evisceration in a postmenopausal woman with previous gynecological surgery. Surgical mesh repair was performed through conventional laparotomy.     

Vaginal cuff dehiscence: risk factors and management

Vaginal cuff dehiscence and evisceration are rare but serious complications of pelvic surgery, specifically hysterectomy. The data on risks of vaginal cuff dehiscence are variable, and there is no consensus on how to manage this complication. In our review, we present a summary of the risk factors, with symptoms, precipitating events, and treatment options for patients with vaginal cuff dehiscence after pelvic surgery. In addition, we provide a review of the current literature on this important surgical outcome and suggestions for future research on the incidence and prevention of vaginal cuff dehiscence.