Abstract
Hysterectomy is one of the commonest major gynecological surgical procedure performed all over the world. It is performed either for benign or malignant gynecological conditions, through abdominal or vaginal route. Hemorrhage,accidental injury to the adjacent organs, wound dehiscence and sepsis are some of the major complications associated with this procedure . We report a rare case of a young woman, who presented with post coital rupture of vaginal vault and prolapse of bowel loop, three months following abdominal hysterectomy for benign condition. Her condition was stable at admission. A rent in the vaginal vault, measuring 4 to 5 centimeters was sutured by vaginal route, in two layers under general anesthesia, after reposition of bowel. She had uneventful postoperative period. She was followed up for a period of one year following repair, for re occurrence of this rare complication. Incidence, causative factors and preventive measures for this condition are discussed in the report.
Highlights
Rupture of the vaginal vault leading to prolapse of intra peritoneal contents through the defect, is a rare, but potentially dangerous complication of total hysterectomy .The reported incidence of vaginal cuff dehiscence following hysterectomy is approximately 0.24 percent[1,2,3]
She had resumed coital activity six weeks after the surgery. She did not have similar complaints during previous sexual contacts. She was taken to her gynecologist on day morning, where she was diagnosed to have post coital rupture of the vaginal vault with prolapse of small intestine through the opening in the vault
Vaginal evisceration after transabdominal hysterectomy with vault rupture and prolapse of small bowel during sexual intercourse is an extremely rare event, and when it occurs, it is considered as a surgical emergency[9,10]
Summary
Rupture of the vaginal vault leading to prolapse of intra peritoneal contents through the defect, is a rare, but potentially dangerous complication of total hysterectomy .The reported incidence of vaginal cuff dehiscence following hysterectomy is approximately 0.24 percent[1,2,3]. She received broad spectrum antibiotics in the peri operative period in the form of injection Cefotaxime 1 gram twice daily and Metronidazole 500 mg intravenously thrice daily for seven days She did not have fever or per vaginal discharge or bleeding after hysterectomy operation .She had one follow up visit after surgery with her gynecologist. She did not have similar complaints during previous sexual contacts She was taken to her gynecologist on day morning, where she was diagnosed to have post coital rupture of the vaginal vault with prolapse of small intestine through the opening in the vault. During the follow up visit, per speculum examination revealed complete healing of the rent without evidence of local sepsis She was further advised to have abstinence for three months and avoidance of forceful coital activity later. Patient did not have recurrence of similar problem during one year of follow up period
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