Transvaginal intestinal evisceration: clinical case

Abstract

: Small bowel evisceration through the vagina is a rare surgical emergency that requires urgent surgical intervention because of the risk of developing acute small bowel ischemia. The clinical case is represented by an 81-year-old patient with vaginal intestinal evisceration, known in the past with 5 natural births, uterine cerclage in the last pregnancy, persistence of vaginal prolapse for 20 years. Gut evisceration was caused by the postmenopausal period, atrophic vagina caused by the enterocele susceptible to rupture from increased intra-abdominal pressure or trauma. From the pathogenic point of view, the lesion of an anatomical structure, as in the case reported by us of the posterior vaginal recess with the evisceration of the small intestine (ileum) in its evolution, initially achieves an inflammatory contact from the first stages. Objectives: to present the surgical emergency, the etiology, the possible complications and the method of choice for the treatment of the given pathology. Material and methods: were composed from the specialty literature, the case was elucidated by surgical intervention through a double approach: transabdomial and transvaginal. The multidisciplinary team was composed of general surgeons, gynecologist and anesthetist. Results: The results of the given case show the importance of rapid resolution of intestinal evisceration to avoid bowel ischemia and minimize the risk of subsequent recurrence. Conclusion: Early detection and surgical management of this rare surgical emergency is imperative to prevent small bowel ischemia that may require resection and the development of sepsis and systemic inflammatory response syndrome due to intestinal necrosis that may ultimately lead to death.