Department of General Surgery, Unit of Gastrointestinal, Hepato-Biliary and Pancreatic Surgery, University Hospital "Alexandrovska", Sofia, Medical University of Sofia, 1 G.Sofiiski Str., 1431, Sofia, Bulgaria.
BMC Surg. 2022 May 4;22(1):157. doi: 10.1186/s12893-022-01615-x.
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.
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.
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.
经阴道肠脱出是一种极其罕见的外科急症，可能导致致命后果。文献中仅描述了 100 多例这种病理。病因也不清楚，具有多因素性。
我们报告了一例 80 岁女性病例，她突然出现严重腹痛，并伴有高级别子宫脱垂，自发性小肠经阴道脱出。肠袢及其系膜呈水肿、增厚和暗紫色，但无明显坏死。紧急行剖腹手术，随后将脱垂的小肠还纳入腹腔，行子宫切除术、部分阴道切除术和阴道关闭术。由于胆囊可见病理改变，因此需要行额外的胆囊切除术。术后恢复顺利。我们病例的独特之处在于，在盆底无力的情况下，没有触发因素（创伤、便秘或增加腹内压的咳嗽发作）导致阴道破裂和肠脱出。
早期发现和手术治疗对于预防肠缺血和腹腔感染至关重要。如果脱出的肠管缺血且不可存活，则需要切除和吻合。手术方法应个体化，并由多学科团队进行。
