ABSTRACT
Aim:
Vaginal evisceration is rarely encountered. Aim of the present study is to report an uncommon case of vaginal evisceration after vaginal hysterectomy in a premenopausal woman without enterocele. Literature is reviewed to study and discuss the predisposing risk factors and management of vaginal evisceration.
Case Report:
A 53 years-old, G4P3A1, premenopausal patient was admitted to the hospital with vaginal evisceration at the postoperative fourth day after hysterectomy (where cuff was left open). Ileum was prolapsed thorough the vagina where it was reduced by emergency laparotomy. Additional culdoplasty was performed to obliterate Douglas pouch. On her previous medical history, she had recurrent rectal prolapse and surgeries for this disorder. Literature was reviewed and discussed along with this case in order to identify risk factors of vaginal evisceration. This information may lead to change of hysterectomy technique in selected patients.
Conclusions:
Diabetes, early coitus, use of steroid, pelvic prolapse, trauma and chronic obstructive respiratory disease are risk factors for vaginal evisceration. Therefore, leaving the kaf open in the hysterectomy technique should be avoided. This is the first case report of vaginal evisceration probably related to rectal prolapse. Rectal prolapse may be an additional risk factor for vaginal evisceration where culdoplasty and suturing of vaginal kaf should be performed to close and restrain the vaginal opening.