Vaginal evisceration: an unexpected complication of conization

Area of Science:

• Gynecologic Oncology
• Surgical Complications
• Cervical Pathology

Background:

• Large loop excision of the transformation zone (LLETZ) is standard for high-grade cervical intraepithelial neoplasia (CIN).
• While uncommon, LLETZ can present serious complications like peritonitis, pseudoaneurysm, and fistula.
• Vaginal evisceration is an exceptionally rare complication following pelvic procedures.

Purpose of the Study:

• To report a unique case of vaginal evisceration after LLETZ.
• To describe the successful surgical management of this rare complication.
• To increase clinician awareness of vaginal evisceration as a potential LLETZ complication.

Main Methods:

• A 73-year-old woman underwent LLETZ for high-grade CIN.
• Postoperative management involved a combined laparoscopic and transvaginal approach.
• Surgical steps included bowel inspection, reinstatement, peritoneal lavage, and wound repair.

Main Results:

• The patient experienced small bowel evisceration through the vagina on postoperative day 3.
• Successful surgical intervention restored bowel integrity and closed the dehiscence.
• The patient's condition was managed effectively through the combined surgical approach.

Conclusions:

• Vaginal evisceration, though rare, is a significant risk following pelvic surgery.
• Prompt recognition and appropriate surgical intervention are crucial for managing this complication.
• This case underscores the importance of considering rare complications in the postoperative care of LLETZ patients.