Laparoscopic Repair of Post-Coital Vaginal Perforation Communicating with the Abdominal Cavity

Abstract

<h3>Study Objective</h3> The objective of this video is to describe an approach to the work-up and surgical management of postcoital vaginal laceration communicating with the abdominal cavity. <h3>Design</h3> N/A. <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> The patient is an 18 y/o G0 who presented 12 hours after intercourse with heavy vaginal bleeding, diffuse abdominal pain, and multiple syncopal episodes. Initial exam was notable for hypotension, diffuse abdominal pain with involuntary guarding, and copious vaginal bleeding from the vagina of unclear origin. <h3>Interventions</h3> A bedside FAST scan demonstrated free fluid in Morrison's pouch. CT scan demonstrated multiple foci of air in the pelvis consistent with vaginal perforation. The patient was taken to the OR for laparoscopic repair of a 4cm full-thickness vaginal perforation communicating with the abdominal cavity, where 300cc of hemoperitoneum was evacuated from the abdominal cavity. An air leak test was performed at the end of the case to ensure no injury to the sigmoid colon. <h3>Measurements and Main Results</h3> The patient received was discharged on POD#1 in stable condition. <h3>Conclusion</h3> Vaginal perforation communicating with the abdominal cavity is a rare complication of intercourse that can have a delayed presentation and occur with hemorrhagic shock. FAST scan can be employed at the bedside to rapidly identify massive hemoperitoneum. Though prior case reports have mainly reported an open repair, a laparoscopic approach is a safe and effective method to repair vaginal defects communicating with the abdominal cavity. Finally, given the high rate of traumatic rectovaginal fistula reported in this population, surgeons should consider the use of an intraoperative air-leak test to confirm colorectal integrity after the repair.