Transvaginal repair of vaginal evisceration of the small bowel: a case report

A. Wielander, W. Kolb, F. Häberlin

Objective

Vaginal evisceration is a rare event, with less than 100 cases reported in the literature. In premenopausal women it can be caused by post-coital vaginal rupture, instrumentation, or iatrogenic injury. It is more common in postmenopausal women with previous hysterectomy or vaginal surgery.

Methods

We report a case of a postmenopausal 61-year-old woman (G2P2) who suffered from a transvaginal small bowel evisceration after lifting a weight of 25 kg. About an one hour before the event she had had sexual intercourse. Two years earlier an abdominal hysterectomy was performed.

Results

On examination in the emergency room we found a 50 cm loop of her small bowel prolapsing through the vaginal introitus. Intravenous morphine was administered for pain control and intravenous metronidazole and cefamandole for prophylactic antibiotic cover. The bowel had been examined for lesions, disinfected and repositioned in the peritoneal cavity. Afterwards in the operating room a high closure of the peritoneum and a colporrhaphy were performed, additionally the peritoneal cavity was drained.

No sequelae were observed in the two years after surgery.

Conclusion

Vaginal evisceration is extremely rare. When it happens, it should be treated immediately as an emergency. Any delay might harm the small bowel. If a bowel or mesenteric injury can reasonably be excluded, the repair by sole vaginal approach can successfully be performed avoiding an abdominal approach.