Transvaginal Evisceration in a Patient With Rectovaginal Prolapse: A Twist in the Tale

Transvaginal evisceration is a rare, potentially life-threatening condition involving herniation of intra-abdominal contents, typically the small bowel, through a defect in the vaginal wall. Most commonly observed in postmenopausal women with a history of pelvic surgery or trauma, it necessitates prompt surgical intervention. We report a unique case of transvaginal evisceration in a 67-year-old postmenopausal female with rectovaginal prolapse following minor trauma. The patient presented with sudden pelvic pain and a mass protruding through the vaginal canal after lifting a heavy object. Examination revealed a loop of small bowel through the vaginal opening. She was hemodynamically stable, and initial management included bowel reduction and intravenous fluid administration. Emergency exploratory laparotomy confirmed a full-thickness defect in the posterior vaginal wall with approximately 40 cm of viable small bowel eviscerated. The defect was repaired with absorbable sutures, and the patient recovered uneventfully, being discharged on postoperative day five. This case underscores the importance of considering transvaginal evisceration in postmenopausal women with rectovaginal prolapse, even after minor trauma, to enable timely intervention and prevent severe complications.