Transvaginal small bowel evisceration after rectal cancer resection

A female in her 70s with a history of rectal cancer resection presented with acute abdominal and pelvic pain following persistent coughing, resulting in a perineal mass. Clinical examination revealed eviscerated loops of congested small bowel through a posterior vaginal wall defect, beyond the introitus. She underwent emergency laparotomy, with combined transabdominal and vaginal reduction of the eviscerated small bowel and repair of posterior vaginal wall defect within 4 hours of presentation. Prompt intervention avoided the need for bowel resection. The patient was discharged on postoperative day 5, commenced on topical vaginal oestriol cream and subsequent urogynaecological follow-up demonstrated a well-healed vault with no initial recurrence of vaginal prolapse. Conservative management was agreed following multidisciplinary team discussion. This case highlights the importance of considering transvaginal evisceration in postmenopausal women with previous pelvic surgery and radiotherapy and the potential use of vaginal oestrogen following repair of vaginal wall defects.