TRANSVAGINAL SMALL-BOWEL EVISCERATION - A CASE-REPORT

Transvaginal small-bowel evisceration is rare. Only 47 case reports ap pear in the literature in English. Review of this literature shows tha t vaginal evisceration occurs mainly in women who are older, multiparo us, and have undergone vaginal surgery. The immediate cause of eviscer ation is either sudden, increased intraabdominal pressure, trauma, or a spontaneous event. The small bowel and omentum are most commonly inv olved. Surgical repair is performed vaginally, abdominally, or by both methods. We present a case of transvaginal small bowel evisceration c aused by inadvertent self-induced trauma, a heretofore unreported caus e of this complication, in a 79-year-old woman with known weakness of her pelvic structural support. She experienced sudden evisceration of small bowel following manual decompression of her cystocele during voi ding. We used a combined abdominal and vaginal approach to examine the small and large intestines and mesentery for trauma, attach the vagin al vault to the shortened uterosacral ligament, obliterate the cul-de- sac using the Moschowitz procedure, and repair the defect in the levat or plate. To limit risk, patients should be evaluated for predisposing conditions. We recommend a combined abdominal and vaginal surgical ap proach to adequately evaluate the involved tissues and to effect repai r.