Vaginal Evisceration Repaired by Sacrocolpopexy: A Case Report and Mini-Review of the Literature

Abstract

Abstract

Background: When reviewing different reported cases of vaginal evisceration, wide variations among them become clear. These variations include menopausal status, hysterectomy or no hysterectomy, route of hysterectomy, its cause, interval between the surgery and evisceration, predisposing factors, and the treatment approaches. This case presentation and mini-review focuses on and blends these different parameters to help gynecologists be well-informed about the condition. Case: An 83-year-old woman was admitted to an emergency department. She had vaginal evisceration of a perforated loop of her small bowel. This occurred 20 years after this patient underwent a vaginal hysterectomy for a uterine prolapse. Through a midline incision, reduction of the small-bowel loops was performed. The perforated vaginal vault was identified, as an 8-cm defect; then, the adherent bowel loops on the posterior vaginal wall (caused by the patient's long-lasting enterocele) were dissected carefully. Closure of the opened vaginal vault was accomplished in two layers, using absorbable sutures (polyglactin, Vicryl 1,^® Ethicon, Johnson & Johnson). Then the closed vault was suspended through sacrocolpopexy, using a polypropylene mesh measuring 4×10 cm. The small-bowel perforation was found 10 cm from the ileocecal junction. After resection of 50 cm of the prolapsed loops, including the perforated site, end-to-end anastmosis was performed. Finally, the patient was put in a lithotomy position to assess the need for any vaginal repair, and a posterior colporrhaphy was done. Results: This patient was returned to the ICU after full recovery. She received analgesia for 48 hours, total parentral nutrition for 8 days, then a gradual oral diet was started. Her abdomen was lax, with no tenderness, and with well-heard peristalsis. The postoperative period was uneventful and this patient was discharged on the eleventh day postsurgery. She was followed up for 1 year with no complications or recurrence of the vault prolapse. Conclusions: Reported cases of vaginal evisceration vary in the literature, with no standardized method of repair. Sacrocolpopexy, using a polypropelene mesh, might be an ideal approach. (J GYNECOL SURG 30:105)