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Small Bowel Obstruction Associated With Post-Hysterectomy Vaginal Vault Prolapse

Carley, Michael E. MD; Bosquet, Jesus Gonzalez MD; Stanhope, C. Robert MD

CASE REPORTS
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BACKGROUND Patients may present with post-hysterectomy vaginal vault prolapse in conjunction with small bowel obstruction. Prior pelvic surgery, malignancy, and radiation therapy may be associated with this presentation.

CASE An 83-year-old multiparous woman with a history of poorly differentiated endometrial adenocarcinoma was treated with radiation therapy, total abdominal hysterectomy, and salpingo-oophorectomy. Anterior exenteration was performed for a recurrence. Seventeen years after her last pelvic operation, she had small bowel obstruction that coincided with a worsening post-hysterectomy vaginal vault prolapse. Surgical management included a side-to-side ileoileostomy and excision with closure of the vaginal apex.

CONCLUSION Although pelvic organ prolapse primarily affects quality of life, clinicians should be alert for bowel obstruction occurring with post-hysterectomy vaginal vault prolapse.

Post-hysterectomy vaginal vault prolapse can be associated with small bowel obstruction, requiring prompt surgical management.

Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota

Address correspondence to: C. Robert Stanhope, MD, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; E-mail: stanhope.robert@mayo.edu.

Received June 19, 2002. Received in revised form October 9, 2002. Accepted November 13, 2002.

© 2003 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.