Vaginal Evisceration After Abdominal Hysterectomy and Vaginal Brachytherapy

Abstract

In Brief Background Rupture of the vaginal vault followed by evisceration of bowel through the vagina is a rare complication after hysterectomy and an unforgettable experience for the physicians involved. Case A 59-year-old white woman underwent abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic lymphadenectomy for endometrial adenocarcinoma International Federation of Gynecology and Obstetrics Stage IIA grade 3. Three high-dose-rate brachytherapy vaginal insertions with iridium were done 5, 6, and 7 weeks postoperatively. Thirteen days after the third insertion, she presented with a pinkish vaginal discharge, a 4-cm rupture in the vaginal vault, and small bowel loops prolapsed into the vagina. A vaginal repair was done. Conclusion This is the first reported case of vaginal evisceration related to iatrogenic trauma at high-dose-rate brachytherapy insertion. Prompt surgical treatment can minimize complications. This is the first reported case of vaginal evisceration related to iatrogenic trauma at the time of high dose rate brachytherapy insertion.