Bowel Evisceration Research Articles

Evisceration of the small bowel through the perineal hernia

Evisceration of the small bowel through the perineal hernia

A case of small bowel evisceration through the rectum and anus

A 46-year-old man presented with a small bowel prolapsing through the anus after straining on the toilet, which was starting to become ischaemic. He admitted to inserting a plastic object in his rectum about half an hour before straining. The bowel was kept moist by placing an intravenous drip line with saline dripping onto a wet swab. In theatre, the bowel was found to be prolapsing through a hole in the upper rectum and out through the anus. It was reduced back into the abdominal cavity through the same perforation, which was 4 cm long, without needing to extend it. This was sutured with polydioxanone (PDS) 2-0 as there was no contamination with faeces or pus. Due to improvement in the appearance of a small bowel and an extremely bruised mesentery, a re-look was planned in 24 hours. At the re-look the small bowel appeared healthy, therefore no resection was performed. However, a loop colostomy was fashioned to protect the upper rectal perforation repair. This shows that resection is not always required in such cases.

Investigation of risk factors for vaginal dehiscence and development of small bowel evisceration after robot-assisted radical cystectomy for female bladder cancer and an improved vaginal reconstruction technique to prevent its onset.

Transvaginal organ prolapse, such as small bowel evisceration, is a rare complication after radical cystectomy (RC) in female patients with invasive bladder cancer, However, it often requires emergency surgical repair. Here, we describe our experience with such a case and a review of similar previously reported cases, along with evaluation of the risk factors. We also propose a vaginal reconstruction technique to prevent this complication during robot-assisted laparoscopic radical cystectomy (RARC). A total of 178 patients who underwent laparoscopic radical cystectomy (LRC) or RARC were enrolled, 34 of whom (19%) were female. One of the 34 female patients had transvaginal small bowel evisceration after RARC. We evaluated our case and six such previously reported cases, to determine vaginal reconstruction techniques during RARC to prevent this complication postoperatively. Median age of these cases was 73 (51-80) years, and all patients were postmenopausal. The median time to small bowel evisceration was 14 (6-120) weeks postoperatively. In addition, we changed the methods of the vaginal reconstruction technique during RARC from the conventional side-to-side closure technique to the improved caudal-to-cephalad closure technique. Since implementing this change, we have not experienced any cases of vaginal vault dehiscence or organ prolapse. Transvaginal small bowel evisceration after RC can easily become severe. Therefore, all possible preventive measures should be taken during RARC. We believe that our vaginal reconstruction techniques might reduce the risk of developing this complication.

Repair of Vaginal Cuff Dehiscence after Laparoscopic Radical Cystectomy with Gracilis Myocutaneous Flap

Vaginal cuff dehiscence after total hysterectomy or total cystectomy had been increasing since laparoscopic or robotic surgery became a common surgery among gynecologists and urologists. A 52-yearold woman underwent laparoscopic radical total cystectomy for muscle invasive bladder carcinoma at Rakuwakai Otowa Hospital. She was emergently admitted with a fist-sized lump protruding from her vagina four months after surgery. Physical examination and her past history on admission disclosed vaginal cuff dehiscence after cystectomy. Computed tomographic scan and magnetic resonance imaging showed no bowel evisceration in the lump. We confirmed that the content of lump was peritoneal tissue and removed it by laparoscopic surgery. Simultaneously, we repaired the vaginal cuff dehiscence with a gracilis myocutaneous flap. There was no subsequent recurrence of vaginal dehiscence or bladder carcinoma in one-year follow-up.

An Unusual Case of Bowel Evisceration after Sneezing

An Unusual Case of Bowel Evisceration after Sneezing

From Rupture to Revelation: Vaginal Evisceration of Small Bowel After Spontaneous Uterine Rupture in Pregnancy

From Rupture to Revelation: Vaginal Evisceration of Small Bowel After Spontaneous Uterine Rupture in Pregnancy

Vaginal vault dehiscence with small bowel evisceration, bowel necrosis, and intra-abdominal haemorrhage: a case report

Abstract Vaginal vault dehiscence with evisceration is a rare but a potentially life-threatening complication of total hysterectomy that requires prompt recognition, diagnosis, and management. The overall incidence of vaginal vault dehiscence is 0.53%. The mortality rate increases to 5.6% when bowel evisceration is present. We report a case of vaginal vault dehiscence with small bowel evisceration complicated by bowel necrosis and intra-abdominal haemorrhage in a 48-year-old woman following her first sexual intercourse 4 months after her total abdominal hysterectomy.

Sneeze-induced transvaginal small bowel evisceration and obstruction nine months after iatrogenic vaginal vault laceration: a case report

Transvaginal evisceration (TE) is the extrusion of intra-abdominal viscera through the vagina. According to the literature, few cases have been reported, most of them involving elderly women who underwent previous pelvic surgery. Here we present the case of a 72-year-old woman who was admitted to our hospital due to the sensation of vaginal obstruction that appeared after a sneeze nine months after a repair of a vault laceration following prior complex pelvic surgery. A clinical diagnosis of small bowel transvaginal evisceration with obstruction was quickly made. In this case, adhesions, bowel obstruction, and the presence of a fibrotic scar on the vaginal vault were the main obstacles to the repair. However, a multidisciplinary evaluation and a combined laparoscopic-transvaginal minimally-invasive approach proved to be safe and effective in achieving good surgical outcomes in the treatment of this condition.

Late Vaginal Cuff Dehisence and Evisceration After Prolapse Surgery: Case Report

Introduction: Vaginal cuff dehiscence (VCD) is rare and may be associated with evisceration of the small bowel. It’s a rare life-threatening condition that is usually seen in postmenopausal women with past history of gynecological surgery. Presentation of Case: A 55-year-old woman presented with sudden-onset abdominal pain and protrusion of a mass through the vagina without triggering factor after two years of a reconstructive prolapse surgery. Physical examination revealed small bowel in the vagina. Laparotomy was performed and the vagina closed. post-op wall sepsis has been controlled. Discussion: Less than 200 cases of VCD have been reported. Most often this event this event occurs acutely; sometimes a triggering factor is found, the most important risk factor being a history of total hysterectomy. Diagnosis is easy Immediate surgery is necessary to reduce the risk of intestinal ischemia and necrosis. Conclusion: VCD must be suspected in any woman with surgical history of total hysterectomy presenting with sudden-onset abdominal/ pelvic pain or swelling. Emergency surgery is necessary to avoid complications which can be serious.

Uterine Perforations Post-Manual Vacuum Aspiration: A Time for Re-Training

Manual vacuum aspiration (MVA) is the recommended surgical procedure for early miscarriages. Yet, its performance by unqualified and inexperienced hands without minimal medical knowledge and skills in the societies of developing nations is not uncommon. This can present some serious life threatening but preventable complications like uterine perforation with resultant intra-abdominal organ injuries that require surgical intervention. General awareness and retraining may decrease unsafe practices and thus reduce maternal morbidity and mortality. We present two cases of young multiparous women who underwent MVA for incomplete miscarriages, which were complicated by anterior and multiple fundal uterine perforations and resultant gangrenous bowel evisceration and entrapment respectively.

Role of laparoscopy in management of patients with anterior abdominal stab wounds.

In this retrospective cohort study, we assessed the utility of laparoscopic surgery for diagnostic and therapeutic purposes in patients with anterior abdominal stab wounds (AASWs). We also investigated patient characteristics that might suggest a greater suitability of laparoscopic interventions. Over a 25-year span, we analyzed AASW patients who had operations, categorizing them based on the presence of significant intra-abdominal injuries and whether they received laparoscopic surgery or laparotomy. We compared variables such as preoperative conditions, surgical details, and postoperative outcomes. We further evaluated the criteria indicating the necessity of direct laparotomies and traits linked to overlooked injuries in laparoscopic surgeries. Of 142 AASWs surgical patients, laparoscopic surgery was conducted on 89 (62.7%) patients. Only 2 (2.2%) had overlooked injuries after the procedure. Among patients without significant injuries, those receiving laparoscopic surgery had less blood loss than those receiving laparotomy (30.0 vs. 150.0ml, p = 0.004). Patients who underwent laparoscopic surgery also had shorter hospital stays (significant injuries: 6.0 vs. 11.0days, p < 0.001; no significant injuries: 5.0 vs. 6.5days, p = 0.014). Surgical complications and overlooked injury rates were comparable between both surgical methods. Bowel evisceration correlated with higher laparotomy odds (odds ratio = 16.224, p < 0.001), while omental evisceration did not (p = 0.107). Laparoscopy is a safe and effective method for patients with AASWs, fulfilling both diagnostic and therapeutic needs. For stable AASW patients, laparoscopy could be the preferred method, reducing superfluous nontherapeutic laparotomies.

Tardive transvaginal small bowel evisceration after colpohysterectomy: a case report of a rare surgical emergency

Transvaginal small bowel evisceration is a rare surgical emergency after gynaecological surgery with around 100 cases described in literature from 1864. Its diagnosis is merely clinical. The surgical treatment is time-depending because of the risk of acute small bowel ischemia. A 71-year-old female presented in our emergency room complaining abdominal pain, vomiting, and small bowel evisceration through the vagina. She suffered gynaecological prolapse and underwent transvaginal hysterectomy four years earlier. At the clinical examination, intestinal loops were oedematous, dusky, vascular sufferance, and without peristalsis. An urgent laparotomy was performed to reduce the prolapsed bowel, resect the ischemic loop, and vaginal cuff closure. Transvaginal bowel evisceration is a delay complication after hysterectomy. It is a life-threatening condition that requires prompt recognition and surgical management.

Transvaginal small bowel evisceration after cervical loop electrosurgical excision procedure: a case report

Transvaginal small bowel evisceration is a life-threatening condition, which is usually seen in postmenopausal women with a history of gynecological surgery. Cervical loop electrosurgical excision procedure (LEEP) is widely used in the treatment of cervical intraepithelial neoplasia (CIN), and its surgical risk and postoperative complications are relatively low because of the simplicity of the operation. However, improper operation may result in perforation of the uterus, which can cause prolapse of the small bowel into the vagina. We here reported an extremely rare case of a young woman with transvaginal small bowel evisceration after cervical LEEP, achieving a good prognosis after the prolapsed bowel was reduced. The patient underwent cervical LEEP as a treatment for CIN III, but the LEEP resulted in a laceration of about 4.0 cm × 3.5 cm on the peritoneum of the uterovesical peritoneal reflection and a laceration of about 2.0 cm × 1.5 cm on the anterior wall of the cervical canal. Through the two lacerations, the pelvic cavity is connected to the vagina and the small intestine prolapsed into the vagina. Due to aggressive surgical intervention, the patient achieved a favorable prognosis after successfully reducing the prolapsed bowel.

Trans-anal small bowel evisceration in a patient with a perforated rectal prolapse

Trans-anal small bowel evisceration in a patient with a perforated rectal prolapse

Transvaginal Evisceration Following Uterine Perforation by Abortion Procedure: About a Case Treated at the Reference Health Center of Commune 1 of Bamako

We report a case of bowel evisceration following uterine perforation after an abortive manoeuvre by unqualified personnel. After the procedure, there was abundant vaginal bleeding and a complication was encountered: small bowel evisceration approximately 1 metre long via the vagina, certainly following the seizure of these small bowels and their successive traction which led first to the uterine cavity, then the vagina and finally to the vulva. Given the author's fear, the patient was referred urgently for treatment. After a transfusion of two units of blood and a triple laparotomy, a 1 m resection of the small intestine with end-to-end anastomosis was performed; suture of the uterine perforation and curettage of the cavity. The patient was discharged from the centre 10 days after surgery. Conclusion: This case shows the clandestine nature of induced abortions, which are responsible for multiple complications, including visceral lesions and uterine perforations.

A rare case of small bowel gangrene and perforation following high voltage electrical injury

This case is a 42-year-old male with an alleged history of electric shock. About 8 h after the insult, an ulcer in the right iliac fossa increased in size with fecal matter coming out. Contrast-enhanced computed tomography of the abdomen revealed a full thickness anterior abdominal wall defect with prolapse of a segment of the distal ileal loop, showing discontinuous wall and no wall enhancement suggestive of evisceration and perforation of bowel with gangrene.

A Rare Case Report of Spontaneous Evisceration of Bowel in an Umbilical Hernia Rupture Patient

A Rare Case Report of Spontaneous Evisceration of Bowel in an Umbilical Hernia Rupture Patient

P-089 SPONTAONEUS BOWEL EVISCERATION IN UMBILICAL HERNIA: CASE REPORT

Abstract Aim Spontaneous rupture of sac of hernia is a less common complication and mainly associated to persistent ascites or congenital wall defects. In literature we have few cases of spontaneous bowel eviscerations in umbilical hernias. Case Report a 53-year-old male years old man addicted to heroin, cocaine and alcohol, presented to the Emergency Department with evisceration of small bowel through an existing umbilical hernia. The patient was conscious and not complaining pain. He stated a protrusion of small bowel through his umbilical skin caused to sudden coughing after assumption of a dose of heroin.In emergency room showed an ileal loop with sub ischemic features. Blood test revealed an hepatitis C infection. During the urgent laparotomy there wasn't evidence of ascites and was necessary to performed an ileal resection and latero-lateral anastomosis with mechanical suturing machine. The placement of a prosthesis was performed; therefore, direct plastic surgery of the abdominal wall. After surgery with a short stay in ICU of 24 hours, the patient was discharged in POD 5. The postoperative course was regular without wound complications. After four months he was free from recurrence and VAS was 0. Conclusions Spontaneous bowel eviscerations in umbilical hernias is associated with refractory ascites in cirrhotic patients or congenital defect. This case is one of few case depicted in literature as spontaneous evisceration of bowel in non cirrhotic patient with umbilical hernia.

Spontaneous Rectal Perforation with Transanal Evisceration of the Small Bowel: A Rare Case Report

Transanal evisceration of the small bowel is a rare surgical emergency. Rectal perforation in such cases is usually due to an underlying rectal prolapse. We report a case of a middle aged (45 years) male with spontaneous rectal perforation and transanal evisceration of the small bowel. Approximately 150 cm of small bowel had eviscerated transanally and the patient required emergent abdominal exploration, reposition of the small bowel, and repair of the rectal perforation. Small bowel evisceration through the anal verge is an emergent condition and the aim was to prevent life threatening complications related to sepsis.

Rare complications of pessary use: A systematic review of case reports.

IntroductionPessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events.MethodsWe performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient‐level data were extracted from case reports to further describe complications on an individual level.ResultsOverall median age of the patients was 82 years (range 62–98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non‐surgical treatment of the complications.ConclusionPessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self‐care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow‐up that is required.