VAGINAL EVISCERATION AFTER ABDOMINAL HYSTERECTOMY

Objective: Vaginal evisceration is rarely encountered. Aim of the present study is to report an uncommon case of vaginal evisceration after abdominal hysterectomy in a premenopausal woman without enterocele. Literature is reviewed to study and discuss the predisposing risk factors and management of vaginal evisceration. Case: A 53 years-old, premenopausal patient was admitted to the hospital with vaginal evisceration at the postoperative fourth day after hysterectomy (where cuff was left open). Ileum was prolapsed thorough the vagina where it was reduced by emergency laparotomy. Additional culdoplasty was performed to obliterate Douglas pouch. On her previous medical history, she had recurrent rectal prolapse and surgeries for this disorder. Literature was reviewed and discussed along with this case in order to identify risk factors of vaginal evisceration. This information may lead to change of hysterectomy technique in selected patients. Conclusions: Diabetes, early coitus, use of steroid, pelvic prolapse, trauma and chronic obstructive respiratory disease are risk factors for vaginal evisceration. Vaginal evisceration shoud be considered during the hysterectomy and postoperative follow up of these patients. Association of rectal prolapse and vaginal evisceration is not reported and this is the first study reporting a relation between rectal prolapse and vaginal evisceration. In our case report, rectal prolaps and previous rectal surgery was a risk factor for vaginal evisceration. Reinforcement of vaginal cuff by culdoplasty and obliteration of vaginal cuff is adviced in these cases