Amakpa Eric Y, Hernandez-Gonzalez Gertrudis A, Camejo-Rodriguez Edith
Ho Teaching Hospital, Department of Obstetrics and Gynecology, Ho. Volta Region, Ghana.
University of Health and Allied Sciences, School of Medicine, Department of Internal Medicine and Therapeutics, Ho. Volta Region, Ghana.
Ghana Med J. 2021 Jun;55(2):156-159. doi: 10.4314/gmj.v55i2.10.
The evisceration of the bowel through the vaginal vault is an extremely rare condition and a surgical emergency with a high-reported mortality rate. Vaginal evisceration most commonly affects menopausal women with a hysterectomy or those with previous vaginal surgery. The most common risk factors include the triad of post-menopausal atrophy, previous vaginal surgery and enterocele. Estrogen deficiency in post-menopausal women leads to weaker pelvic support structures and a thin, atrophic vagina, making it more prone to rupture. Previous vaginal surgery leaves scar tissue with diminished vascularity in the vaginal wall and apex, predisposing it to dehiscence. Post hysterectomy, the axis of the vagina may be changed, making it more vertical or shortened and resulting in the vagina losing its valve-like mechanism. We present a 70-year-old female brought to the emergency department with a vaginal prolapse complicated by bowel evisceration, without any history of vaginal surgery, hysterectomy or trauma. The bowel was inspected and irrigated copiously, then reduced into the abdominal cavity as it was still viable. A total vaginal hysterectomy with an anterior and posterior colporrhaphy was done. The patient had a successful recovery with no complication. We present this case due to its rarity, the absence of previous vaginal surgery, trauma, or hysterectomy and the successful multidisciplinary surgical approach with total recovery.
None.
经阴道穹窿发生肠管脱出是一种极其罕见的情况，属于外科急症，报告的死亡率很高。阴道肠管脱出最常影响接受过子宫切除术的绝经后女性或既往有阴道手术史的女性。最常见的危险因素包括绝经后萎缩、既往阴道手术和肠膨出三联征。绝经后女性雌激素缺乏会导致盆腔支持结构变弱，阴道变薄、萎缩，使其更容易破裂。既往阴道手术会在阴道壁和顶端留下血管减少的瘢痕组织，使其易于裂开。子宫切除术后阴道轴可能改变，使其更垂直或缩短，导致阴道失去其瓣膜样机制。我们报告一例70岁女性，因阴道脱垂合并肠管脱出被送至急诊科，该患者无任何阴道手术、子宫切除术或外伤史。对肠管进行检查并大量冲洗，由于肠管仍有活力，将其还纳回腹腔。实施了全阴道子宫切除术及前后阴道壁修补术。患者恢复良好，无并发症。我们报告此病例是因其罕见性、无既往阴道手术、外伤或子宫切除术史以及采用多学科手术方法成功实现完全康复。
无。
