Transvaginal small bowel evisceration: Case report and review of literature

INTRODUCTION: Transvaginal evisceration is a rare life-threatening condition that is usually seen in postmenopausal women with past history of gynaecological surgery. PRESENTATION OF CASE: A 54-year-old woman presented with sudden-onset abdominal pain and protrusion of a mass through the vagina after her grandson jumped on her abdomen while at play. She had undergone laparoscopic total hysterectomy and bilateral salpingo-oophorectomy 9 months earlier. Physical examination revealed an intestinal loop in the vagina. She was immediately taken to the operating room. Laparotomy was performed and the prolapsed intestine was reduced. The bowel from the duodenojejunal junction to the ileocecal valve looked healthy, with no areas of ischemia. The rupture in the vaginal vault was repaired with Vicryl. The postoperative course was uneventful, and the patient was discharged on day 5 after the surgery. DISCUSSION: Less than 100 cases of transvaginal evisceration have been reported. The condition, which is more common in postmenopausal women, usually presents with sudden-onset abdominal pain. Some patients may be asymptomatic and only complain of swelling at the introitus. Diagnosis can usually be made by visual examination. Immediate surgery is necessary to reduce the risk of intestinal ischemia and necrosis. CONCLUSION: Transvaginal evisceration must be suspected in any woman presenting with sudden-onset abdominal/pelvic pain. Awareness of this rare condition is necessary to minimize mortality.