Background Vaginal vault rupture with intestinal hernaiation, although rare, is a recognized postoperative complication of vaginal and abdominal hysterectomies. The incidence after laparoscopic hysterectomy is unkown.
Cases Three women, ages 40–43 years, presented to the emergency room with bleeding and pain 2–5 months after total laparoscopic hysterectomy. The small bowel was visible through the introitus or protruding into the vagina. Inspection of the bowel revealted no evidence of trauma. Two vaginal cuff repairs were completed transvaginally and one laparscopically, all with interrupted sutures of no. 0 polydioxanone or polyglactin. In follow-up period of 12–17 months, the patients were doing well.
Conclusion Total laparoscopic hysterectomy may be associated with an increase risk of vaginal vault evisceration. Because laparoscopy increasingly is used to replace abdominla hysterectomy, it is important to be aware of this complication and its management.
Address reprint request to: Ceana Nezhat, MD, Stanford Endoscopy Center for Training and Technology, 900 Welch Road, Suite 403, Palo Alto, CA 94304
© 1996 The American College of Obstetricians and Gynecologists