VAGINAL EVISCERATION - PRESENTATION AND MANAGEMENT IN POSTMENOPAUSAL WOMEN

BACKGROUND: Vaginal evisceration is a rare event, often associated wit h previous vaginal surgery in postmenopausal women. To date, 57 cases have been described in the world literature since 1901. STUDY DESIGN: We report three cases of vaginal evisceration and review risk factors and management described in the current literature. RESULTS: Of 60 rep orted cases of vaginal evisceration, 41 occurred in postmenopausal wom en. A common triad of previous vaginal surgery (73 percent), postmenop ausal status (68 percent), and the presence of an enterocele (63 perce nt) was identified. Histopathologic evaluation of one case revealed a chronic vaginal-peritoneal fistula, and immunohistochemistry highlight ed migration of squamous cells to multiple peritoneal serosal surfaces . This finding emphasizes the chronic nature of factors that predispos e to the acute evisceration of abdominal contents, Most eviscerations were managed by primary repair of the vaginal disruption and the accom panying disorder of the pelvic floor, after assessing the viability of the prolapsed bowel and resecting any compromised segments. However, most surgeons agreed that delayed vaginal repair was preferable if the vaginal tissues appeared acutely inflamed or nonviable. CONCLUSIONS: Vaginal evisceration is primarily seen with obstetrical or postcoital trauma, but in postmenopausal women it is most often associated with a history of vaginal surgery and a pelvic support disorder, Hypoestroge nism, atrophy, and devascularization from previous surgery seem to pla y a significant role. Management is directed toward resecting any comp romised bowel, repairing the vaginal defect, and correcting the contri buting defect in the pelvic floor.