Late Omental Evisceration Following Sacrospinous Ligament Fixation: A Case Report and a Focused Literature Review

Vaginal vault dehiscence with evisceration is a rare but severe complication following pelvic reconstructive surgery. Late presentations after sacrospinous ligament fixation (SSLF) are particularly uncommon. We report a rare case of late vaginal vault dehiscence with omental evisceration in a menopausal patient 2 years after SSLF, along with a structured review of the literature.

A 65-year-old menopausal woman presented with acute pelvic pain and vaginal protrusion of omental tissue 13 years after a vaginal hysterectomy and 2 years after SSLF. Examination revealed a 2-cm vaginal cuff defect with omental evisceration. She underwent urgent transvaginal surgery, including partial omentectomy, reduction of viable tissue, vaginal cuff repair, and McCall culdoplasty.

Recovery was uneventful.

Late vaginal vault dehiscence after SSLF is rare but should be considered a surgical emergency. Our accompanying literature review highlights the spectrum of delayed presentations, common triggers, and management strategies, emphasizing the need for long-term surveillance. Isolated omental evisceration may represent a precursor phase of vault failure before bowel involvement. Prompt diagnosis and management are essential to prevent progression to bowel involvement and associated morbidity.