Subtle vaginal evisceration resulting in small bowel evisceration: a case report

Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction.

We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence.

A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room.

Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.