eP302 Laparoscopic Repair of Vaginal Evisceration Post-Vaginal Hysterectomy: A Case Report

Introduction In vaginal evisceration, abdominal viscera herniate through a vaginal wall defect or rupture. This rare condition is seen primarily in post-menopausal people following vaginal surgery. Timely recognition and surgical management are paramount for preventing bowel ischemia, necrosis, and perforation. Clinical case A 76-year-old female presented, 18 months post-vaginal hysterectomy, to the emergency department with vaginal bleeding and lower abdominal pain following straining on defecation. On examination, she was hemodynamically stable with approximately 15cm of small bowel, including its mesentery, eviscerated through the vaginal vault. There was no evidence of ischemia. Care was, therefore, shared between general surgery and gynaecology. An abdominal pelvis CT scan showed stenosis of the eviscerated small bowel and upstream dilation of the pelvic small bowel. The patient was transferred to the operating theatre for laparoscopic reduction of small bowel herniation through the vaginal vault. The vaginal cavity was packed to maintain the pneumoperitoneum. Examination under anaesthetic and laparoscopic inspection revealed viable small bowel with fibrinous exudate, vaginal vault prolapse, and a rectocele, alongside a vaginal vault defect of 2.5 cm which was repaired with absorbable sutures. Gynaecology advised repairing the prolapse later. The patient’s recovery was uncomplicated and supported with laxatives (to prevent straining) and intravenous antibiotics. She was discharged on postoperative day four. Discussion We describe a rare surgical emergency, vaginal evisceration, which requires prompt bowel reduction to prevent morbidity and mortality. Whilst there are several approaches, our case demonstrates the utility of one that is laparoscopic for patients with viable, non-ischemic bowel.