A Case of Transvaginal Small Bowel Evisceration following Hysterectomy with Discussion of Emergency Department Diagnosis and Management.
Matthew ApicellaMaximiliano MayrinkChetan D RajadhyakshaDavid A FarcyPublished in: Case reports in emergency medicine (2022)
Transvaginal small bowel evisceration is a rare surgical emergency that requires urgent surgery to prevent bowel necrosis, sepsis, and death. It was first reported in 1864 by Hyernaux with less than 100 cases reported since the original publication. The overall mortality rate is reported as 5.6 percent. We present the case of a 49-year-old woman who presented to the emergency department with a chief complaint of moderate abdominal pain and vaginal bleeding for 1 hour. The patient reported that she underwent a robotic-assisted laparoscopic hysterectomy 11 weeks prior for uterine fibroids. Visual examination revealed a loop of the small bowel coming from the superior aspect of her vagina. Literature reviews have noted a higher incidence of dehiscence following robotic-assisted total laparoscopic hysterectomy. It is important for the emergency physician to make the diagnosis, initiate prompt consultation with departments of obstetrics and gynecology and general surgery, and treat for potential infection.
Keyphrases
- small bowel
- emergency department
- patient reported
- abdominal pain
- robot assisted
- risk factors
- minimally invasive
- systematic review
- palliative care
- blood pressure
- intensive care unit
- public health
- coronary artery bypass
- cardiovascular events
- atrial fibrillation
- healthcare
- acute kidney injury
- high intensity
- type diabetes
- adverse drug
- single cell
- cardiovascular disease
- gestational age
- risk assessment
- septic shock
- coronary artery disease
- percutaneous coronary intervention
- emergency medical