• Dong Hyung Lee, Eun Taeg Kim, Hyun Been Jo, Seo Yoon Hwang, Nam Kyung Lee, Dong Soo Suh, and Ki Hyung Kim.
• Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea.
• Medicine (Baltimore). 2022 Apr 29; 101 (17): e29225e29225.

RationaleTransvaginal evisceration of the small bowel is an extremely rare condition after hysterectomy, which requires urgent surgical intervention to prevent serious bowel morbidity and mortality.Patient ConcernsA 65-year-old woman presented with sudden-onset severe abdominal pain and a mass protruding through the vagina. The past surgical history was significant, with an abdominal hysterectomy for cervical cancer performed 11 weeks prior to presentation.DiagnosisPelvic examination revealed prolapsed small-bowel loops (18-20 cm in length). Pelvic computed tomography scan confirmed the presence of transvaginal evisceration of the small bowel.InterventionsBowel reduction and urgent laparotomy were the selected treatment approaches for a detailed inspection and thorough washing of the intrα-abdominal cavity. A Foley catheter was inserted in the emergency room, with the subject in the lithotomy position. The prolapsed bowel loops spontaneously reduced without manual reduction, and the vault defect was repaired transvaginally.OutcomesThe patient experienced no postoperative complications and remained disease-free for 9months postoperatively.LessonsTransvaginal evisceration of the small bowel should be considered a surgical emergency. A multidisciplinary approach to prompt case management involving clinicians in gynecology, general surgery, and emergency medicine is vital for preventing serious consequences. Hysterectomy is the most frequently performed gynecological surgical procedure, and evisceration occurs most often after hysterectomy. Therefore, patients should be informed about this rare but possible hysterectomy complication.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

33 keywords...

hide…