Management of transvaginal bowel evisceration secondary to vaginal vault dehiscence following hysterectomy: Case report and review of the literature
DOI:
https://doi.org/10.18597/rcog.3141Keywords:
Surgical wound dehiscence, visceral prolapse, hysterectomyAbstract
Objetives: To report a case of transvaginal bowel evisceration following total abdominal hysterec- tomy, and to conduct a review of the literature on its diagnosis and treatment.
Materials and Methods: A 48-year-old female patient who presented to a high complexity insti- tution with transvaginal bowel evisceration lasting 10 hours. Laparotomy was performed in order to reduce the evisceration and repair the vaginal vault defect. A search was conducted in Medline via PubMed, Embase, Elsevier, Medigraphic, Wolt- ers Kluwer Health and UpToDate using the terms “vaginal vault dehiscence,” “transvaginal bowel evisceration,” “dehiscence following hysterectomy,” “hysterectomy complications,” and using a snowball search strategy based on the studies identified, both in English and Spanish.
Results: Fourteen studies were included. The diagnosis of transvaginal evisceration is primarily clinical with the observed bulging of the abdominal content through the vagina. It may also be associated with signs of peritonitis or bowel obstruction. Initial management must be an attempt at vaginal packing and prophylactic antibiotics. Several surgical techniques have been described for vaginal vault correction and reinforcement of dehiscence closure.
Conclusions: Transvaginal evisceration is consid- ered a surgical emergency. Further studies assessing the safety and effectiveness of the various manage- ment interventions are required.
Author Biographies
Santiago Rueda-Espinel, Universidad Industrial de Santander
Médico cirujano, Universidad Industrial de Santander, Bucaramanga (Colombia).
Facundo Cobos-Mantilla, Hospital Universitario de Santander
Especialista en ginecobstetricia. Profesor de cátedra, Universidad Industrial de Santander-Hospital Universitario de Santander, Bucaramanga (Colombia).
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