Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer: A case report

• Published in: Medicine (Baltimore) Vol. 101; no. 17; p. e29225
• Main Authors: Lee, Dong Hyung, Kim, Eun Taeg, Jo, Hyun Been, Hwang, Seo Yoon, Lee, Nam Kyung, Suh, Dong Soo, Kim, Ki Hyung
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 29.04.2022
• Subjects: Abdominal Pain - surgery; Aged; Clinical Case Report; Female; Humans; Hysterectomy - adverse effects; Hysterectomy - methods; Intestine, Small - surgery; Laparotomy - methods; Prolapse; Uterine Cervical Neoplasms - surgery; Vagina - surgery
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000029225

Transvaginal evisceration of the small bowel is an extremely rare condition after hysterectomy, which requires urgent surgical intervention to prevent serious bowel morbidity and mortality. A 65-year-old woman presented with sudden-onset severe abdominal pain and a mass protruding through the vagina. The past surgical history was significant, with an abdominal hysterectomy for cervical cancer performed 11 weeks prior to presentation. Pelvic examination revealed prolapsed small-bowel loops (18-20 cm in length). Pelvic computed tomography scan confirmed the presence of transvaginal evisceration of the small bowel. Bowel reduction and urgent laparotomy were the selected treatment approaches for a detailed inspection and thorough washing of the intrα-abdominal cavity. A Foley catheter was inserted in the emergency room, with the subject in the lithotomy position. The prolapsed bowel loops spontaneously reduced without manual reduction, and the vault defect was repaired transvaginally. The patient experienced no postoperative complications and remained disease-free for 9months postoperatively. Transvaginal evisceration of the small bowel should be considered a surgical emergency. A multidisciplinary approach to prompt case management involving clinicians in gynecology, general surgery, and emergency medicine is vital for preventing serious consequences. Hysterectomy is the most frequently performed gynecological surgical procedure, and evisceration occurs most often after hysterectomy. Therefore, patients should be informed about this rare but possible hysterectomy complication.