Spontaneous transvaginal small bowel evisceration following hysterectomy: a case report

Transvaginal small bowel evisceration is a rare, life-threatening condition, requiring urgent surgical intervention. In our case, ischemia developed in the intestinal segment with evisceration, with a laceration in the small intestine of the mesentery, and finally, a small bowel resection was required. An 89-year-old woman was brought to the hospital with a sudden onset of abdominal pain, which lasted for 4 hours. Upon the examination, it was found that approximately 50 cm of the small intestine was eviscerated from the vagina, with its mesentery. The intestines were edematous, and also there were signs of ischemia on the mesentery. The patient was urgently transferred to surgery. Functional end-to-end anastomosis was performed, following a 70 cm small bowel resection. The vaginal defect was repaired transvaginally. Transvaginal small bowel evisceration is rarely described in the literature. It is most commonly seen in postmenopausal, elderly women who underwent vaginal surgery before and who have enterocele. The treatment is an emergent surgical approach. Surgical treatment should be based on individual patient. Various surgical techniques have been described for the repair of transvaginal small bowel evisceration, such as vaginal, abdominal, laparoscopic, and combined approaches. Transvaginal small bowel evisceration should be considered in the differential diagnosis of patients with a sudden onset abdominal pain. Patients with an increased risk for transvaginal small bowel evisceration are postmenopausal women and patients who underwent vaginal surgery before. After the accurate diagnosis, patients should be operated as soon as possible, and necessary surgery should be done.

Histerektomi sonrasý geç dönem transvajinal ince baðýrsak evisserasyonu: Olgu sunumu

Transvajinal ince baðýrsak evisserasyonu nadir görülmekle birlikte, taný konulduðu anda acil cerrahi giriþim gerektiren bir klinik tablodur. Olgumuzda da evissere olan baðýrsak segmentinde iskemi bulgularý geliþmiþ, ince baðýrsak mezosunda yýrtýk oluþmuþ ve ince baðýrsak rezeksiyonu yapýlmasý gerekmiþtir. Seksen dokuz yaþýnda kadýn hasta dört saattir olan ani baþlayan karýn aðrýsý, baðýrsaklarýn vajinadan çýkma þikayeti ile getirildi. Hastanýn yapýlan muayenesinde yaklaþýk 50 cm’lik ince baðýrsak ansýnýn mezosu ile birlikte vajenden evissere olduðu görüldü. Baðýrsak anslarý ödemli olup, yer yer iskemi bulgularý ve mezoda yýrtýlma mevcuttu. Hasta acil olarak ameliyata alýndý. Yetmiþ cm’lik ince baðýrsak rezeksiyonunu takiben fonksiyonel uc-uca anastomoz yapýldý. Vajen defekti transvajinal olarak çift kat üzerinden tamir edildi. Transvajinal ince baðýrsak evisserasyonu literatürde az rastlanan bir durumdur. En sýk postmenapozal, yaþlý, daha önceden geçirilmiþ vajinal ameliyatý olan, enteroseli olan kadýnlarda görülmektedir. Tedavisi acil cerrahi giriþimdir. Yapýlacak cerrahi hastanýn bulgularýna göre transvajinal olarak vajen güdüðünün tamir edilmesinden, laparotomi yapýlmasýna hatta baðýrsak rezeksiyonu yapýlmasýna kadar deðiþiklik gösterebilir. Postmenapozal, daha önceden geçirilmiþ vajinal ameliyatý olan hastalar gibi risk taþýyan hastalar ani baþlayan karýn aðrýsý ile baþvurduklarýnda transvajinal ince baðýrsak evisserasyonu da ayýrýcý tanýda düþünülmelidir. Tanýsý konulduktan sonra da hastalar en kýsa sürede ameliyata alýnýp gerekli cerrahi giriþim yapýlmalýdýr.