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Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse

BACKGROUND: Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral. CASE PRESENTATION: We report the case o...

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Autores principales: Arabadzhieva, Elena, Bulanov, Dimitar, Shavalov, Zhivko, Yonkov, Atanas, Bonev, Sasho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066937/
https://www.ncbi.nlm.nih.gov/pubmed/35509095
http://dx.doi.org/10.1186/s12893-022-01615-x
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author Arabadzhieva, Elena
Bulanov, Dimitar
Shavalov, Zhivko
Yonkov, Atanas
Bonev, Sasho
author_facet Arabadzhieva, Elena
Bulanov, Dimitar
Shavalov, Zhivko
Yonkov, Atanas
Bonev, Sasho
author_sort Arabadzhieva, Elena
collection PubMed
description BACKGROUND: Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral. CASE PRESENTATION: We report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness. CONCLUSIONS: Early detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team.
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spelling pubmed-90669372022-05-04 Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse Arabadzhieva, Elena Bulanov, Dimitar Shavalov, Zhivko Yonkov, Atanas Bonev, Sasho BMC Surg Case Report BACKGROUND: Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral. CASE PRESENTATION: We report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness. CONCLUSIONS: Early detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team. BioMed Central 2022-05-04 /pmc/articles/PMC9066937/ /pubmed/35509095 http://dx.doi.org/10.1186/s12893-022-01615-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Arabadzhieva, Elena
Bulanov, Dimitar
Shavalov, Zhivko
Yonkov, Atanas
Bonev, Sasho
Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse
title Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse
title_full Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse
title_fullStr Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse
title_full_unstemmed Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse
title_short Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse
title_sort spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066937/
https://www.ncbi.nlm.nih.gov/pubmed/35509095
http://dx.doi.org/10.1186/s12893-022-01615-x
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