Posthysterectomy Vaginal-Vault Rupture: A Clinical Rarity

Abstract

Background: Total abdominal hysterectomy is associated with many potential complications including infection, hemorrhage, and damage to other structures. Posthysterectomy vaginal-vault rupture is a recognized but very rare complication that should not be ignored as a differential in female patients presenting with acute abdominal symptoms. Case: We present the case of a 49-year-old woman who presented with acute abdominal pain with no vaginal symptoms, and who had undergone abdominal hysterectomy 3 months prior. She was in shock and had localized peritonism, and a pneumoperitoneum was diagnosed on erect chest radiography. A diagnosis of vaginal vault rupture was made on examination under anesthesia, and an emergency laparotomy was performed. The defect in the vaginal vault was repaired and the patient went on to make an uneventful recovery. Conclusions: As this condition is very rare, it is important that general practitioners, emergency doctors, and surgeons be aware of the diagnosis so that cases are not confused with other causes of pelvic pain. A high index of suspicion with prompt initiation of appropriate investigations and treatment is the key to ensure better patient outcome. (J GYNECOL SURG 26:195)