Evisceration after vaginal cuff dehiscence: A case report and review

Introduction: Intestinal loop Evisceration (VE) complicates the 35- 67% Of Vaginal Cuff Dehiscence (VCD), constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Clinical case: 94-year-old patient with VE after VCD, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Results: Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: VE requires vaginal, abdominal or mixed repair, generally deferring the definitive treatment of the prolapse to a second stage. We recommend being very careful with vaginal vault closure after any type of hysterectomy, avoiding electrosurgery, infection and bleeding, performing the colporrhaphy with bidirectional barbed suture or two layers with braided suture and facing enough tissue at the suture. Keywords: Vaginal evisceration; Vaginal cuff dehiscence; Complications after hysterectomy; Long-standing pessary.

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Intestinal Loop Evisceration after Vaginal Cuff Dehiscence: A Case Report and Review

Women Health Care and Issues ◽

10.31579/2642-9756/042 ◽

2021 ◽

Vol 04 (01) ◽

pp. 01-06

Author(s):

Sonia Manso

Keyword(s):

Intestinal Resection ◽

Genital Prolapse ◽

Medical Emergency ◽

Intestinal Loop ◽

Vaginal Cuff ◽

Vaginal Evisceration ◽

Vaginal Repair ◽

Vaginal Cuff Dehiscence ◽

Omentum Flap

Background: Intestinal loop evisceration complicates 35-67% of vaginal cuff dehiscence, constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Complications associated with the use of a pessary are rare. They are usually due to loss of patient follow-up or negligent use of the device. Clinical presentation: We present the case of a 94-year-old patient who debuted with vaginal evisceration after vaginal cuff dehiscence, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: EV requires vaginal, abdominal, or mixed repair, generally deferring definitive prolapse treatment to a second stage and we recommend being very careful with the closure of the vaginal vault after any type of hysterectomy

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Coitus Induced Vaginal Evisceration Through Vaginal Cuff Dehiscence After Radical Hysterectomy - A Rare Case Report

Medical Case Reports ◽

10.21767/2471-8041.100050 ◽

2017 ◽

Vol 03 (02) ◽

Author(s):

Nishat Fatema ◽

Houda Nasser Al Yaqoubi ◽

Mahin Rahman ◽

Muna Mubarak Al Badi

Keyword(s):

Case Report ◽

Radical Hysterectomy ◽

Rare Case ◽

Vaginal Cuff ◽

Vaginal Evisceration ◽

Rare Case Report ◽

Vaginal Cuff Dehiscence

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Decreased Incidence of Vaginal Cuff Dehiscence after Laparoscopic Closure with Bidirectional Barbed Suture

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2011.01.002 ◽

2011 ◽

Vol 18 (2) ◽

pp. 218-223 ◽

Cited By ~ 74

Author(s):

Matthew T. Siedhoff ◽

Amanda C. Yunker ◽

John F. Steege

Keyword(s):

Barbed Suture ◽

Vaginal Cuff ◽

Vaginal Cuff Dehiscence ◽

Laparoscopic Closure

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Recurrent vaginal cuff dehiscence after surgery for endometriosis: a technique for laparoscopic repair with an omental flap

BMJ Case Reports ◽

10.1136/bcr-2020-239540 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239540

Author(s):

Gerard-Peter Frank ◽

Johann Rhemrev ◽

Marinke Westerterp ◽

Jim English

Keyword(s):

Laparoscopic Approach ◽

Omental Flap ◽

Sexually Active ◽

Management Options ◽

Vaginal Cuff ◽

Vaginal Evisceration ◽

Tissue Healing ◽

Laparoscopic Excision ◽

Vaginal Cuff Dehiscence

Vaginal evisceration is a rare but severe complication after hysterectomy or colpotomy and is generally successfully repaired by reapproximating healthy tissue edges of the vagina. Recurrent vaginal cuff dehiscence is problematic especially in sexually active women. We describe two cases of recurrent vaginal cuff dehiscence. The first patient had a hysterectomy for endometriosis. The second patient underwent laparoscopic excision of an endometriotic nodule at the vaginal vault. The vaginal cuff dehiscence was repaired by a laparoscopic approach employing an omental flap to enhance tissue healing. This closure technique turned out to be successful at follow-up in both cases. In case of recurrent vaginal cuff dehiscence, management options are limited. Our case report offers a laparoscopic treatment option by using an omental flap. This procedure can be used when conventional repair fails.

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Vaginal Treatment of Vaginal Cuff Dehiscence with Visceral Loop Prolapse: A New Challenge in Reparative Vaginal Surgery?

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/257398 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Salvatore Andrea Mastrolia ◽

Edoardo Di Naro ◽

Luca Maria Schonauer ◽

Maria Teresa Loverro ◽

Beatrice Indellicati ◽

...

Keyword(s):

Vaginal Surgery ◽

Medical Intervention ◽

Vaginal Vault ◽

Intestinal Loop ◽

Vaginal Cuff ◽

Postmenopausal Patient ◽

Total Hysterectomy ◽

Vaginal Cuff Dehiscence ◽

Long Time ◽

Vaginal Cuff Closure

Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy and refers to separation of the vaginal cuff closure. The term vaginal cuff dehiscence is frequently interchanged with the terms of cuff separation or cuff rupture. All denote the separation of a vaginal incision that was previously closed at time of total hysterectomy. After dehiscence of the vaginal cuff, abdominal or pelvic contents may prolapse through the vaginal opening. Bowel evisceration, outside the vulvar introitus, can lead to serious sequelae, including peritonitis, bowel injury and necrosis, or sepsis. Therefore, although prompt surgical and medical intervention is required to replace prolapsed structures, the main problem remains the reconstruction of vaginal vault. In case of recent hysterectomy, vaginal reparation only requires the approximation of vaginal walls, including their fascia, while if dehiscence occurs after a long time from hysterectomy, the adequate suspension of the vaginal vault has to be taken into consideration. In this report we describe the case of a postmenopausal patient, undergoing surgical emergency because of the evisceration of an intestinal loop through a dehiscence of vaginal vault, after numerous reconstructive vaginal surgeries for vaginal prolapse. This paper analyzes clinical circumstances, risk factors, comorbidity, and clinical and surgical management of this complication.

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