Acute Small Bowel Evisceration Through Vaginal Cuff Following Intercourse After Total Laparoscopic Hysterectomy: A...

Vaginal cuff dehiscence (VCD) with bowel evisceration is a rare but serious post-operative complication following hysterectomy, particularly associated with minimally invasive surgical approaches. It carries significant morbidity and requires prompt diagnosis and surgical intervention. We report the case of a 43-year-old woman who presented with post-coital acute lower abdominal pain and evisceration of bowel through the vagina 3 months after undergoing a total laparoscopic hysterectomy for heavy menstrual bleeding. On examination, large loops of small bowel were noted to be eviscerated through the vaginal canal, with pieces of tissue paper adhered to the eviscerated bowel. Emergent surgical exploration was performed, revealing a dehisced vaginal cuff with underlying viable bowel. The bowel was reduced, the vaginal cuff was repaired transvaginally, and an exploratory laparoscopy was performed with the remaining adherent tissue paper being left on the bowel. The patient recovered without complication and was discharged after a 3-day hospital stay. VCD with evisceration is a rare complication that requires high clinical suspicion, particularly in posthysterectomy patients presenting with pelvic pain, vaginal bleeding or protrusion. Timely surgical management is essential to avoid bowel ischaemia and other complications. Awareness of risk factors and careful surgical technique during cuff closure at the time of hysterectomy may help prevent this potentially life-threatening condition. This case also highlights the unique and novel occurrence of tissue paper being left intra-abdominally at the time of surgery in support of potential conservative management in these instances.