Vaginal evisceration
Medical intervention
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Key Takeaways
- Vaginal evisceration is an evisceration of the small intestine that occurs through the vagina, typically subsequent to vaginal hysterectomy, and following sexual intercourse after the surgery.
- Presentation Vaginal evisceration is typically obvious upon presentation, as intestine (typically ileum) can be seen protruding from the introitus.
- Complications Complications of surgery can include injury to the bladder, rectum, or ureter, especially in cases where there has been tissue necrosis.
- Causes Vaginal evisceration is a serious complication of dehiscence (where a surgical wound reopens after the procedure), which can be due to trauma.
- Most instances of vaginal evisceration following a laparoscopic hysterectomy result from sexual intercourse among women approaching menopause, and from the combination of heightened pressure within the abdomen and weakened vaginal muscles among those who have experienced menopause.
Vaginal evisceration is an evisceration of the small intestine that occurs through the vagina, typically subsequent to vaginal hysterectomy, and following sexual intercourse after the surgery. It is a surgical emergency.
Presentation
Vaginal evisceration is typically obvious upon presentation, as intestine (typically ileum) can be seen protruding from the introitus. Other symptoms include a sense of pressure in the pelvis and vaginal bleeding.
Complications
Complications of surgery can include injury to the bladder, rectum, or ureter, especially in cases where there has been tissue necrosis. Surgeons typically perform intraoperative cystoscopy with dye to assess potential bladder or ureter injuries.
Causes
Vaginal evisceration is a serious complication of dehiscence (where a surgical wound reopens after the procedure), which can be due to trauma. 63% of reported cases of vaginal evisceration follow a vaginal hysterectomy (where the uterus removal surgery is performed entirely through the vaginal canal). Most instances of vaginal evisceration following a laparoscopic hysterectomy result from sexual intercourse among women approaching menopause, and from the combination of heightened pressure within the abdomen and weakened vaginal muscles among those who have experienced menopause. Other risk factors include regular Valsalva maneuver, advanced age, obesity, smoking, immunosuppressive therapy, vaginoplasty, anemia, poor surgical technique, malnutrition, and postoperative/perioperative infection. One case has been reported as of 2015 where placement of a pessary caused an evisceration.
Dehiscence is more common in laparoscopic hysterectomy than in open hysterectomy.
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