Rupture of the vaginal vault followed by evisceration of bowel through the vagina is a rare complication after hysterectomy and an unforgettable experience for the pelvic surgeon involved.
A 49-year-old woman was successfully treated for vaginal evisceration after coitus 5 months following abdominal hysterectomy. Etiological factors are discussed.
Vaginal evisceration, although exceedingly uncommon, has been reported most frequently in postmenopausal women. Most have had a history of multiple vaginal operations or an enterocele. In such cases, either the postmenopausal vagina is thin, scarred, and foreshortened, predisposing to spontaneous rupture, or an already atrophic postmenopausal vagina is further stretched by an advancing enterocele, making it susceptible to rupture from increasing intraabdominal pressure or trauma. Emergency management consists of stabilzation, fluid therapy, wrapping the bowel with moist saline sponges, early antibiotic therapy, radiographs to rule out foreign bodies, and prompt surgical intervention. The primary goal of the repair, whether by the abdominal or vaginal route, is to resect any nonviable bowel and necrotic vaginal tissue, thoroughly irrigate the contaminated areas, and repair the vaginal rupture.
Prompt recognition and surgical treatment, combining abdominal and vaginal approaches as indicated, and use of ancillary antibiotics and anticoagulant regimens are associated with successful outcome in most instances.
Department of Obstetrics & Gynecology, New Hanover Regional Medical Center, Coastal Area Health Education Center, Wilmington, North Carolina
Received for publication November 14, 2000; accepted December 15, 2000.
Correspondence and reprint requests: John L. Powell, MD, Director of Gynecologic Oncology, Coastal Area Health Education Center, PO Box 9025, Wilmington, NC 28402-9025.