A CASE OF VAGINAL VAULT DEHISCENCE WITH SMALL BOWEL EVISCERATION FOLLOWING TOTAL ABDOMINAL HYSTERECTOMY

Abstract

Vaginal vault dehiscence is a rare but
potential morbid complication of hysterectomy.
The reported incidence of cuff
dehiscence after a hysterectomy varies
according to the surgical approach. The
rate is higher after laparoscopic hysterectomy
(0.79 to 1.5 percent) compared
with abdominal (0.1 to 0.26 percent) or
vaginal hysterectomy(0.08 to 0.25 percent).
After dehiscence of the vaginal
cuff, abdominal or pelvic contents may
be expelled through the vaginal opening.
Bowel evisceration can lead to serious
sequelae, including peritonitis, bowel injury
and necrosis, and sepsis. Prompt
surgical and medical intervention are required
to prevent such complications and
it is a surgical emergency. We describe a
case of 40 yrs old female with recent history
of abdominal hysterectomy presenting
to us with prolapse of a 15-20 cm
loop of small intestine. The patient successfully
underwent laporotomy with repositioning
of the
prolapsed intestinal loops into abdominal
cavity with mesenteric tear repair and vault
closure.