Spontaneous Transvaginal Small Bowel Evisceration After Laparoscopic Hysterectomy

Vaginal cuff dehiscence can be a rare complication of total hysterectomy, with an estimated prevalence of 0.032% to 1.25% and a high mortality rate of 6 to 10%. Dehiscence is also reported in cases following total laparoscopic hysterectomy, with a prevalence of 0.87%. This case report details the emergency management of a 59-year-old female who complained of abdominal and pelvic pain and the feeling of a foreign body in her vagina. The patient reported a history of laparoscopic total hysterectomy 6 months prior to presenting at the Emergency Department. A clinical examination revealed small bowel loops protruding through the vagina. The patient underwent exploratory laparotomy through a Pfannenstiel incision, and the terminal ileum was found prolapsing through the vaginal cuff. The bowel loops were identified as viable and the vagina was sutured. The patient had an unremarked post operative course. This case report showcases that in patients with transvaginal evisceration, immediate surgical management is crucial in order to avoid serious life threatening complications, and both surgeons and gynecologists should remain vigilant regarding this pathology.