A Rare Case of Transvaginal Sigmoid Evisceration in a Patient with Recurrent Pelvic Organ Prolapse

Large bowel evisceration is a rare but morbid presentation that requires timely diagnosis and management. We present the case of a 67-year-old woman with a history of recurrent pelvic organ prolapse (notably with a history of prior hysterectomy, mesh-augmented sacrocolpopexy, and transvaginal Uphold™ mesh placement). She presented with the subjective report of subacute worsening of her prolapse leading to urinary retention managed with a Foley catheter and an irreducible vaginal mass prompting evaluation. Clinical evaluation revealed bowel contents in the vagina with subsequent initiation of intravenous antibiotics, diagnostic laparoscopy converted to exploratory laparotomy, and resection of sigmoid and upper rectum with creation of left ileal end colostomy. Common risk factors for bowel evisceration include older age, postmenopausal status, history of pelvic surgery, and pessary use. In a patient with subacute worsening of prolapse and pain with the above risk factors, bowel evisceration should be considered and ruled out.