Case report:
A 72-year-old patient, who underwent a 10 years ago a total vaginal
hysterectomy for a mild disease, was admitted for abdominal pain with a
loop of bowel prolapsed from her vagina, after an uplifting effort
(Figure1).
The physical examination showed an evisceration of small bowel with
satisfying vitality due to dehiscence of the vaginal cuff. Multiple
loops of the small bowel and abdominal mesentery were involved. A
digital rectal exam confirmed that there was no involvement of the
rectum. We did not complete any radiological examination. We decided to
operate on the patient in an emergency context. The preoperative blood
tests were normal.
Under general anesthesia and after administration of intravenous
antibiotics, the patient was placed in Trendelenburg position, and the
loop of bowel was integrated into the abdominal cavity with a manual
reduction (Figure 2 and 3) through the vaginal defect and the defect was
repaired with a non-absorbable running suture (Figure 4). Post-operative
period was uncomplicated; the patient was discharged on the
8th post-operative day and was addressed to the
genecology team to fix the vaginal cuff dehiscence.