Acute abdomen due to vaginal impalement

Abstract

Acute abdomen is a common and often complicated condition inthe emergency department. Etiology may vary from harmless toextremely severe causes, any of which can present the samenonspecific symptoms. Impalement or penetrating injuries of thelower genital tract are rare and frequently related to unusual sexualhabits [2]. Evaluating the mechanism of trauma may be difficult aspatients are often unwilling or unable to provide the necessaryinformation.An 18-year-old woman presented at the emergency departmentwith sudden and severe lower abdominal pain in the early morning.Initial history did not reveal trauma or previous illness.Physical examination showed a tense abdomen with diffuseguarding and rare bowel sounds. Laboratory evaluation showed awhite blood cell count of 25.7/nL and C-reactive protein of 84 mg/L.Urinalysis exhibited 150 Ery/μL, 100 leukocytes/μL, and a negativepregnancytest. Abdominal ultrasound was normal but X-rayrevealedair in the peritoneal cavity.Laparoscopy was performed for suspected gastrointestinal perfo-ration. Turbid and blood-stained perihepatic fluid was found andhyperemia of the parietal peritoneum was suggestive of earlyperitonitis. No perforation was found in the upper abdomen. In therectovaginal pouch there was a 4-cm wide laceration through thevagina vault, with transvaginal loss of carbon dioxide gas.Following irrigation with 5 liters of warm saline, repair wasperformed laparoscopically with a continuous PDS II suture (3-0,Lahodny) and fixed with two resorbable clips. Intravenous cephazolin(3×2 g) and metronidazole (2×500 mg) were administered to thepatient for 7 days. Review of the gynecologic history revealed forcefulsexual intercourse as the cause of the injury. The patient's recoveryfrom surgery was uneventful.Impalement injuries of the vagina are seldom described in theliteratureandincludesevereinjuriesoftherectum,bladder,peritoneal,duodenum, diaphragm, and lung [1–3].The most common symptom in women with vaginal impale-ment injury is vaginal bleeding after coitus with no history ofcongenital abnormalities, gynecologic operation, pregnancy, orbirth [4]. Careful gynecologic history is necessary and should beaccompanied by vaginal examination and ultrasound or radiogra-phy when indicated.Vaginal bleeding as the classical symptom was absent in thepresent case and the clinical aspect was that of an acute abdomenwith diffuse peritonitis. In such cases, full evaluation may lead tolaparoscopy.Conflict of interestNo conflicts of interest exist.References