Peritonitis caused by vaginal evisceration following laparoscopy-assisted vaginal hysterectomy

Abstract

This report describes a rare case of omentum evisceration via the vagina, causing peritonitis after an uncomplicated laparoscopy-assisted vaginal hysterectomy. Vaginal evisceration is a surgical emergency requiring immediate treatment. A 41-year-old G0 P0 woman was referred to our unit owing to a palpable abdominal mass. She decided to undergo a hysterectomy instead of myomectomy after counseling. Laparoscopy-assisted vaginal hysterectomy was performed without complication. The uterus was removed via colpotomy and the vault with the peritoneum was closed using a series interrupted No. 1-0 Vicryl sutures; the vault was also fixed to pelvic ligaments. Intravenous antibiotic cefazoline (Winston, Taiwan) 2 g was administered intraoperatively. Although we recommended respite, she did not comply owing to work obligations. She denied any sexual activity after the surgery. Two months later, she was presented to our clinic with abdominal pain and vaginal bleeding for 1 day. Physical examination revealed rebound tenderness in the lower abdomen and a soft protruding mass from the vaginal cuff associated with lifting pain was found on pelvic examination. Laboratory data demonstrated an elevated white blood cell (WBC) count of 13.63 THSD with a neutrophil count of 79.8%. The patient’s vital signs were normal. She was taken to the operating room and antibiotic cefmetazole (Japan, Daiichi Sankyo) 2 g IV stat and 1 g IV q6h were administered. Laparoscopic examination revealed an eviscerated edematous omentum, which was reduced to the peritoneal cavity (Fig. 1). The vaginal cuff was repaired via the vaginal route using interrupted 1-0 Vicryl sutures. She was strongly advised to not do activities that required heavy lifting for 2 months.