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Toh JWT, Lee T, Chiong C, Ctercteko G, Pathma-Nathan N, El Khoury T, Wright D, King J. Transvaginal evisceration of small bowel. ANZ J Surg 2018; 89:774-776. [PMID: 29316216 DOI: 10.1111/ans.14290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- James W T Toh
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Taina Lee
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Corinna Chiong
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Grahame Ctercteko
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Nim Pathma-Nathan
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Toufic El Khoury
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Danette Wright
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Jennifer King
- Division of Gynaecology, Department of Surgery, Westmead Hospital, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
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2
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Gheewala U, Agrawal A, Shukla R, Bhatt R, Srivastava S. Transvaginal small bowel evisceration in known case of uterine prolapse due to trauma. J Clin Diagn Res 2015; 9:PD09-10. [PMID: 25738028 PMCID: PMC4347119 DOI: 10.7860/jcdr/2015/10345.5411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
Abstract
Spontaneous transvaginal bowel evisceration is a rare surgical emergency with only a few cases reported and particularly postmenopausal, posthysterectomy, multiparous elderly women are considered to be at higher risk for development of bowel evisceration. It is difficult to manage such a patient for any surgeon and poses significant challenges especially intraoperatively. Here, we report a case of vaginal vault rupture with small bowel evisceration through the vagina in a known case of uterine prolapse and highlight the risk factors, clinical presentation, and treatment options for this rare surgical emergency.
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Affiliation(s)
- Umesh Gheewala
- Assistant Professor, Department of Surgery, Shree Krishna Hospital, Karamsad, India
| | - Abhishek Agrawal
- Resident, Department of Surgery, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, India
| | - Radha Shukla
- Student,Pramukhswami Medical College, Karamsad, India
| | - Ravi Bhatt
- Student,Pramukhswami Medical College, Karamsad, India
| | - Shirish Srivastava
- Professor and Head, Department of Surgery, Shree Krishna Hospital, Karamsad, India
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3
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Vaginal treatment of vaginal cuff dehiscence with visceral loop prolapse: a new challenge in reparative vaginal surgery? Case Rep Obstet Gynecol 2014; 2014:257398. [PMID: 25525534 PMCID: PMC4265380 DOI: 10.1155/2014/257398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/17/2014] [Indexed: 12/03/2022] Open
Abstract
Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy and refers to separation of the vaginal cuff closure. The term vaginal cuff dehiscence is frequently interchanged with the terms of cuff separation or cuff rupture. All denote the separation of a vaginal incision that was previously closed at time of total hysterectomy. After dehiscence of the vaginal cuff, abdominal or pelvic contents may prolapse through the vaginal opening. Bowel evisceration, outside the vulvar introitus, can lead to serious sequelae, including peritonitis, bowel injury and necrosis, or sepsis. Therefore, although prompt surgical and medical intervention is required to replace prolapsed structures, the main problem remains the reconstruction of vaginal vault. In case of recent hysterectomy, vaginal reparation only requires the approximation of vaginal walls, including their fascia, while if dehiscence occurs after a long time from hysterectomy, the adequate suspension of the vaginal vault has to be taken into consideration. In this report we describe the case of a postmenopausal patient, undergoing surgical emergency because of the evisceration of an intestinal loop through a dehiscence of vaginal vault, after numerous reconstructive vaginal surgeries for vaginal prolapse. This paper analyzes clinical circumstances, risk factors, comorbidity, and clinical and surgical management of this complication.
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Veciana Colillas M, Vicedo Madrazo E, Iglesias Ferreiro S, Monje Beltran M, Marqueta Sanchez J. Evisceración vaginal con antecedente de cirugía pélvica: 2 casos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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El-Tawab SS, Nagati AA. Vaginal Evisceration Repaired by Sacrocolpopexy: A Case Report and Mini-Review of the Literature. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2012.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sally S. El-Tawab
- El-Shatby Maternity University Hospital, Alexandria University, Shatby, Alexandria, Egypt
| | - Ahmed A. Nagati
- El-Shatby Maternity University Hospital, Alexandria University, Shatby, Alexandria, Egypt
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Orito S, Masuya N, Sakurabashi A, Minoura S. Vaginal evisceration 3 years after abdominal hysterectomy and bilateral salpingo-oophorectomy. J Obstet Gynaecol Res 2012; 38:1385-8. [DOI: 10.1111/j.1447-0756.2012.01877.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Vaginal cuff dehiscence: risk factors and management. Am J Obstet Gynecol 2012; 206:284-8. [PMID: 21974989 DOI: 10.1016/j.ajog.2011.08.026] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 08/17/2011] [Accepted: 08/23/2011] [Indexed: 11/24/2022]
Abstract
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.
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Eid-Arimoku L, Trompetas V. Postcoital vaginal rupture after hysterectomy presenting as generalised peritonitis. Ann R Coll Surg Engl 2011; 93:e136-7. [PMID: 22004623 DOI: 10.1308/147870811x602140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Postcoital vaginal rupture is a rare but well documented complication of hysterectomy. Evisceration of the small intestine, vaginal bleeding and pelvic pain are common presenting features. We report the unusual case of vaginal rupture presenting with generalised peritonitis without vaginal evisceration.
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Affiliation(s)
- L Eid-Arimoku
- Eastbourne District General Hospital, Eastbourne, UK
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10
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Subtle vaginal evisceration resulting in small bowel evisceration: a case report. J Emerg Med 2011; 43:e125-8. [PMID: 21903354 DOI: 10.1016/j.jemermed.2011.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 02/14/2011] [Accepted: 06/01/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction. OBJECTIVE We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence. CASE REPORT A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room. CONCLUSION Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.
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Halwani Y, Nicolau-Toulouse V, Oakes J, Leipsic J, Geoffrion R, Wiseman SM. Transvaginal strangulated small intestinal hernia after abdominal sacrocolpopexy: case report and literature review. Hernia 2011; 17:279-83. [PMID: 21761210 DOI: 10.1007/s10029-011-0848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To report a case of transvaginal small intestinal hernia following abdominal sacrocolpopexy and review this clinical presentation in the current literature. METHODS A review of our case and a literature review of vaginal evisceration were carried out. RESULTS The patient underwent sacrocolpopexy and a Burch procedure. Six months later, a recurrent enterocele through a 1 cm defect in the vaginal vault was diagnosed. Several weeks later she presented with an incarcerated and strangulated loop of small intestine extending beyond the introitus. This required an urgent exploratory laparotomy, ileocecal resection, and vaginal vault closure. Postoperatively, she experienced gradual prolapse recurrence and is currently successfully managed with a pessary. Risk factors that include vaginal atrophy, chronic constipation, and previous pelvic surgery may have contributed to the evisceration, mesh erosion, and may have caused the breakdown in the vaginal vault mucosa ultimately responsible for the evisceration. In addition, placement of the sacrocolpopexy mesh without tension, and utilization of an interposition graft to reinforce the weakened vaginal vault tissue, are aspects of the surgical procedure that may influence outcomes. At the time of evisceration repair, the best approach to resuspend the vaginal vault, and prevent recurrent prolapse or evisceration, is currently unknown. CONCLUSION Vaginal evisceration is a potential complication of abdominal sacrocolpopexy. Early recognition and treatment of this complication is critical, and prolapse recurrence may occur even after surgical repair.
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Affiliation(s)
- Y Halwani
- Department of Surgery, St Paul's Hospital and University of British Columbia, C 303-1081 Burrard Street, Vancouver, BC, V6Z 3W8, Canada
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Patravali N, Kulkarni T. Bowel evisceration through the vaginal vault: a delayed complication following hysterectomy. J OBSTET GYNAECOL 2007; 27:211. [PMID: 17454489 DOI: 10.1080/01443610601157695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- N Patravali
- Glan clwyd Hospital, 5 Clos Dinbych, Bodelwyddan, Rhyl, Denbighshire, Wales. UK.
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Delotte J, Iannelli A, Fayad S, Dahman M, Saïdi-Oliver M, Gugenheim J, Bongain A. [Vaginal evisceration. Report of a new case]. ACTA ACUST UNITED AC 2005; 33:126-8. [PMID: 15848084 DOI: 10.1016/j.gyobfe.2005.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 02/14/2005] [Indexed: 10/25/2022]
Abstract
Vaginal evisceration is rare and most commonly found in postmenopausal women. We report the case of a postmenopausal woman due to ruptured enterocele. Surgical treatment was done through a midline laparotomy and consisted of bowel resection with primary anastomosis and vaginal vault suture repair. Risk factors for this rare clinical entity are discussed along with the different therapeutic options.
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Affiliation(s)
- J Delotte
- Service de gynécologie-obstétrique, reproduction et médecine foetale, hôpital Archet-II, 151, route de Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice cedex 03, France.
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