2022, Number 10
<< Back Next >>
Ginecol Obstet Mex 2022; 90 (10)
Transvaginal bowel evisceration due to vaginal vault deshicence following a hysterectomy: case report
Triviño-Cuéllar LS, Garzón-Pulido LS, Quintero-Mora LF, Geney-Montes MC, Niño-González JE
Language: Spanish
References: 15
Page: 850-855
PDF size: 207.40 Kb.
ABSTRACT
Background: Vaginal vault dehiscence is a rare complication of hysterectomy,
secondary to risk factors that alter healing. Its incidence and prevalence are low and
when it occurs it is a surgical emergency.
Objective: To report the clinical case of a patient with transvaginal intestinal evisceration
and to review the diagnostic and therapeutic procedure and compare it with
that reported in the literature.
Clinical case: A 67-year-old female patient with a four-hour clinical picture of
abdominal pain associated with vaginal mass sensation. History of previous oncologic
surgery. Physical examination revealed intestinal evisceration without necrosis. During
the surgical procedure a three centimeter defect of the vaginal vault was evidenced.
The repair was performed by abdominal and vaginal access, without complications.
Postoperatively she presented with multifactorial oxygen desaturation, was treated,
monitored and discharged from the hospital. She attended postoperative controls in
which she was found with adequate clinical evolution.
Conclusion: Transvaginal evisceration is rare, when it occurs it needs to be diagnosed
and treated immediately, to counteract associated complications. In this case,
the patient received multidisciplinary care with adequate postoperative evolution. Due
to the low incidence, there is insufficient evidence to recommend an ideal access route
for surgical treatment.
REFERENCES
Ramirez PT, Klemer DP. Vaginal evisceration after hysterectomy:a literature review: Obstet Gynecol Survey 2002;57 (7): 462-7. doi:10.1097/00006254-200207000-00023
Hur HC, Lightfoot M, McMillin MG, Kho KA. Vaginal cuffdehiscence and evisceration: a review of the literature. CurrOpin Obstet Gynecol 2016; 28 (4): 297-303. doi:10.1097/GCO.0000000000000294
Ceccaroni M, Berretta R, Malzoni M, Scioscia M, RoviglioneG, Spagnolo E, et al. Vaginal cuff dehiscence after hysterectomy:a multicenter retrospective study. Eur J ObstetGynecol Reprod Biol 2011; 158 (2): 308-13. doi:10.1016/j.ejogrb.2011.05.013
Fuchs WN, Einarsson JI, Wang KC, Vitonis AF, Cohen SL.Vaginal cuff dehiscence: risk factors and associated morbidities.JSLS 2015; 19 (2): e2013.00351. doi: 10.4293/JSLS.2013.00351
Ben Safta Y, Ghalleb M, Baccari A, Hamdi El kebir G, DaldoulS, Sayari S, et al. Vaginal cuff dehiscence and evisceration 11years after a radical hysterectomy: A case report. Int J SurgCase Rep 2017; 41: 234-7. doi:10.1016/j.ijscr.2017.10.045
Gandhi P, Jha S. Vaginal vault evisceration. Obstetrician& Gynaecologist 2011; 13 (4): 231-7. doi:10.1576/toag.13.4.231.27688
Cronin B, Sung VW, Matteson KA. Vaginal cuff dehiscence:risk factors and management. Am J Obstet Gynecol 2012;206 (4): 284-8. doi:10.1016/j.ajog.2011.08.026
Hur H-C, Donnellan N, Mansuria S, Barber RE, Guido R,Lee T. Vaginal cuff dehiscence after different modes ofhysterectomy. Obstet Gynecol 2011; 118 (4): 794-801. doi:10.1097/AOG.0b013e31822f1c92
Kim MJ, Kim S, Bae HS, Lee JK, Lee NW, Song JY. Evaluationof risk factors of vaginal cuff dehiscence after hysterectomy.Obstet Gynecol Sci 2014; 57 (2): 136. doi:org/10.5468/ogs.2014.57.2.136
Croak AJ, Gebhart JB, Klingele CJ, Schroeder G, Lee RA,Podratz KC. Characteristics of patients with vaginal ruptureand evisceration: Obstet Gynecol 2004; 103 (3): 572-6. doi:10.1097/01.AOG.0000115507.26155.45
Yildirim D, Ozyurek SE, Kiyak H, Han A, Koroglu N, Bestel A,et al. Single-layer versus double-layer closure of the vaginalcuff with barbed sutures in laparoscopic hysterectomy.Ginekol Pol 2018; 89 (5): 6. doi:10.5603/GP.a2018.0040
Uccella S, Ceccaroni M, Cromi A, Malzoni M, Berretta R, DeIaco P, et al. Vaginal cuff dehiscence in a series of 12,398hysterectomies: effect of different types of colpotomy andvaginal closure. Obstet Gynecol 2012; 120 (3): 516-23.http://10.1097/AOG.0b013e318264f848
Rajesh S, Kalu E, Bong J, Wales N. Evisceration 5 yearspost abdominal hysterectomy: Evisceration. J ObstetGynaecol Res 2008; 34 (3): 425-7. doi:10.1111/j.1447-0756.2008.00778.x
Matthews CA, Kenton K. Treatment of vaginal cuff evisceration.Obstet Gynecol 2014; 124 (4): 705-8. doi:10.1097/AOG.0000000000000463
MacKoul P, Danilyants N, Sarfoh V, van der Does L, Kazi N.A Retrospective review of vaginal cuff dehiscence: comparingabsorbable and nonabsorbable sutures. J MinimInvasive Gynecol 2020; 27 (1): 122-8. doi:org/10.1016/j.jmig.2019.03.002
Full text