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

Mandana Sigaroudinia, David Bowden, Deb Maitra, Graham Cawdell

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DOI: 10.4236/ss.2011.22017                

Abstract

Small bowel evisceration through the vagina is a rare condition, which tends to affect post-menopausal women who have undergone vaginal hysterectomy. It is a surgical emergency with a favourable outcome if diagnosed and treated in a timely fashion. Delay in diagnosis can precipitate infarction of small bowel loops with associated morbidity and mortality. Treatment involves laparotomy, reduction of the incarcerated loops (plus/minus small bowel resection) and repair of the vaginal rupture. The purpose of this paper is to report a case of small bowel evisceration through the vagina, to review the literature pertaining to this topic and to raise awareness of this condition in the general surgical community.

Keywords

Small Bowel Evisceration, Vaginal Rupture, Hysterectomy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. E. Dunn, “Disruption of Vaginal Wound with Evisceration; Eighteen Months Following Vaginal Hysterectomy,” Journal Of The Michigan State Medical Society, Vol. 49, No. 8, 1950, pp. 925-927.
[2]	F. W. Kayser, N. S. Heaney and H.C. Dahleen, “Spontaneous Evisceration through Vaginal Enterocele,” American Journal of Obstetrics & Gynecology, Vol. 61, No. 6, 1951, pp. 1393-1394.
[3]	A. J. Croak, J. B. Gebhart, C. J. Klingele, G. Schroeder, “Characteristics of Patients with Vaginal Rupture and Evisceration,” Obstetrics & Gynecology, Vol. 103, No. 3, 2004, pp. 572-576. doi:10.1097/01.AOG.0000115507.26155.45
[4]	P. T. Ramirez, D. P. Klemer, “Vaginal Evisceration after Hysterectomy: a Literature Review,” Obstetrical & Gynecological Survey,Vol. 57, No. 7, 2002, pp. 462-467. doi:10.1097/00006254-200207000-00023
[5]	K. Yuce, P. Dursun, M. Gultekin, “Postheyterectomy Intestinal Prolapse after Coitus and Vaginal Repair,” Arch Gynecological Obstetrical, Vol. 272, No. 1, 2005, pp. 80-81. doi:10.1007/s00404-004-0709-8
[6]	A. M. Burkett, D. E. Cohn, L. J. Copeland, “Vaginal Evisceration during Intraperitoneal Chemotherapy for Advanced Ovarian Cancer,” Gynecologic Oncology, Vol. 104, No. 2, 2007, pp. 491-493. doi:10.1016/j.ygyno.2006.10.029
[7]	J. L. Powell, M. B. Meyerson, “Vaginal Evisceration after Abdominal Hysterectomy and Vaginal Brachytherapy,” Journal of Pelvic Medicine and Surgery, Vol. 9, No. 3, 2003, pp. 125-128. doi:10.1097/01.SPV.0000074090.17386.38
[8]	Y. Avidor, R. Rub, Y. Kluger, “Vaginal Evisceration Resulting from a Water Slide Injury,” Journal Of Trauma Injury, Infection And Critical Care, Vol. 44, No. 2, 1998, pp. 415-416. doi:10.1097/00005373-199802000-00038
[9]	W. D. Kang, S. M. Kin, H. S. Choi, “Vaginal Evisceration after Radical Hysterectomy and Adjuvant Radiation,” Journal of Gynecologic Oncology, Vol. 20, No. 1, 2009, pp. 63-64. doi:10.3802/jgo.2009.20.1.63
[10]	A. A. Kambouris, B. H. Drukker, J. Barron, “Vaginal Evisceration. A Case Report and Brief Review of the Literature,” Archives of Surgery, Vol. 116, No. 7, 1981, pp. 949-51.
[11]	M. D. Moen, M. Desai, R. Sulkowski, “Vaginal Evisceration Managed by Transvaginal Bowel Resection and Vaginal Repair,” International Urogynecology Journal and Pelvic Floor Dysfunction, Vol. 14, No. 3, 2003, pp. 218-220. doi:10.1007/s00192-003-1056-1
[12]	F. Narducci, Y. Sonoda, E. Lambaudie, E. Leblanc, “Vaginal Evisceration after Hysterectomy: the Repair by a Laparoscopic and Vaginal Approach with an Omental Flap,” Gynecologic Oncology, Vol. 89, No. 3, 2003, pp. 549-551. doi:10.1016/S0090-8258(03)00153-7
[13]	D. Jurus, P. Finamore, B. Vakill, “Use of Synthetic Mesh to Prevent Recurrent Vaginal Evisceration: A Case Report,” International Urogynecology Journal and Pelvic Floor Dysfunction, Vol. 20, No. 2, 2009, pp. 259-260. doi:10.1007/s00192-008-0699-3
[14]	C. Crespi and A. M. De Giorgio, “Prolapse of the Vaginal Vault Complicated by Ileal Evisceration. Possible Role of Dacron Mesh in Emergencies,” Gynecologic Chiropractic, Vol. 12, No. 10, 1991, pp. 498-500.
[15]	V. Brehm, P. Steenvoorde, J. Oskam, “Vaginal Evisceration of Small Bowel Loops Following Prior Vaginal Hysterectomy: A Graciloplasty Performed to Reconstruct the Rectovaginal Septum,” International Journal of Surgery, Vol. 6, No. 6, 2008, pp. 34-35. doi:10.1016/j.ijsu.2006.11.004
[16]	R. D. Moore, J. R. Miklos, “Repair of Vaginal Evisceration Following Colpocleisis Utilizing an Allogenic Dermal Graft,” International Urogynecology Journal and Pelvic Floor Dysfunction, Vol. 12, No. 3, 2001, pp. 215-217. doi:10.1007/PL00004035