Evisceración vaginal espontánea en paciente con antecedente de histerectomía: reporte de caso y revisión de la literatura / Spontaneous vaginal evisceration in woman with prior pelvic surgery: case report and literature review

Reportar un caso de evisceración vaginal espontánea en paciente con antecedentes quirúrgicos de histerectomía vaginal y hacer una revisión de la literatura sobre los principales factores de riesgo asociados a la presentación de este evento. Se presenta el caso de una paciente de 74 años multípara de 12 partos vaginales con antecedente ginecológico de histerectomía vaginal en 2012, en el año 2014 una sacroespinocolpopexia con colocación de cinta transobturadora más colporrafia anterior, en 2018 presenta cuadro con asas intestinales protruyendo con signos de isquemia a través de defecto en cúpula vaginal, se realiza resección de intestino delgado y anastomosis termino-terminal, con posterior cierre de defecto por vía abdominal. Se realizó una búsqueda en las bases de datos PubMed, Scielo, Google Scholar y Science Direct para artículos publicados en inglés y español, de los últimos 22 años. Se identificaron 16 títulos que cumplieron con los criterios de selección, los resultados de la revisión muestran factores de riesgo comunes. La evisceración vaginal por dehiscencia de la cúpula vaginal es una patología poco prevalente, el abordaje mínimamente invasivo, que ha aumentado en los últimos años, ha conllevado un aumento de la incidencia, siendo la histerectomía por laparoscopia el de mayor riesgo.

To report a case of spontaneous vaginal evisceration in a patient with a surgical history of vaginal hysterectomy, and to review the literature on the main risk factors associated with the presentation of this event. We present the case of a 74-year-old multiparous patient with 12 vaginal deliveries with a gynecological history of vaginal hysterectomy in 2012, in 2014 a sacrospinocolpopexy with placement of transobturator tape plus anterior colporrhaphy, in 2018 she presented with intestinal loops protruding with signs of ischemia through a defect in the vaginal vault, resection of the small intestine and end-to-end anastomosis were performed, with subsequent closure of the defect through the abdomen. A search was made in the PubMed, Scielo, Google Scholar and Science Direct databases for articles published in English and Spanish, from the last 22 years. 16 titles that met the selection criteria were identified; the results of the review show common risk factors. Vaginal evisceration due to dehiscence of the vaginal vault is a rare pathology, the minimally invasive approach, which has increased in recent years, has led to an increase in incidence, with laparoscopic hysterectomy being of greater risk.

Management of transvaginal bowel evisceration secondary to vaginal cuff dehiscence following hysterectomy: Case report and review of the literature / Manejo de evisceración intestinal transvaginal secundaria a dehiscencia de la cúpula vaginal posterior a histerectomía: reporte de caso y revisión de la literatura

ABSTRACT Objetives: To report a case of transvaginal bowel evisceration following total abdominal hysterectomy, and to conduct a review of the literature on its diagnosis and treatment. Materials and methods: A 48-year-old female patient who presented to a high complexity institution with transvaginal bowel evisceration lasting 10 hours. Laparotomy was performed in order to reduce the evisceration and repair the vaginal vault defect. A search was conducted in Medline via PubMed, Embase, Elsevier, Medigraphic, Wolters Kluwer Health and UpToDate using the terms "vaginal vault dehiscence," "transvaginal bowel evisceration," "dehiscence following hysterectomy," "hysterectomy complications," and using a snowball search strategy based on the studies identified, both in English and Spanish. Results: Fourteen studies were included. The diagnosis of transvaginal evisceration is primarily clinical with the observed bulging of the abdominal content through the vagina. It may also be associated with signs of peritonitis or bowel obstruction. Initial management must be an attempt at vaginal packing and prophylactic antibiotics. Several surgical techniques have been described for vaginal vault correction and reinforcement of dehiscence closure. Conclusions: Transvaginal evisceration is considered a surgical emergency. Further studies assessing the safety and effectiveness of the various management interventions are required.

RESUMEN Objetivos: reportar un caso de evisceración intestinal transvaginal posterior a histerectomía abdominal total y realizar una revisión de la literatura sobre su diagnóstico y tratamiento. Materiales y métodos: se presenta el caso de una paciente de 48 años que consulta a una institución de alta complejidad por evisceración intestinal transvaginal de 10 horas de evolución, se realiza laparotomía para reducción de la evisceración y reparación del defecto de cúpula vaginal. Se hace una búsqueda en Medline vía PubMed, Embase, Elsevier, Medigraphic, Wolters Kluwer Health y UpToDate con los términos: "dehiscencia de cúpula vaginal", "evisceración intestinal transvaginal", "dehiscencia posterior a histerectomía", "complicaciones histerectomía", y en bola de nieve a partir de los estudios identificados, en idiomas inglés y español. Resultados: se incluyeron 14 estudios. El diagnóstico de la evisceración transvaginal es eminentemente clínico al observar salida de contenido abdominal por vagina, se puede asociar a signos de peritonitis u obstrucción intestinal. Su manejo inicial debe intentar el empaquetamiento vaginal y la profilaxis antibiótica Se han descrito varias técnicas quirúrgicas para corregir el defecto de la cúpula vaginal y reforzar el cierre de la dehiscencia de la cúpula. Conclusiones: la evisceración transvaginal se considera una urgencia quirúrgica. Se requieren más estudios que evalúen la seguridad y la efectividad de las diferentes intervenciones para el manejo.

Vaginal evisceration related to genital prolapse in premenopausal woman

ABSTRACT Background Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation. Case Report A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation. Case hypothesis This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.

Transvaginal evisceration after abdominal hysterectomy. Case report / Evisceración transvaginal post histerectomía abdominal. Reporte de un caso

Evisceration is a condition in which abdominal viscera protrude through an unnatural hole, with an incidence between 0.03 and 4.1%. This condition often occurs after an abdominal hysterectomy (47%), vaginal hysterectomy (29.4%) or laparoscopic approach (23.6%). It has the highest incidence in hysterectomized postmenopausal women, while the time interval between surgery and complication onset may vary from a few days to a few years. Moreover, in most cases, the eviscerated organ is the small intestine, which represents a surgical emergency. Transvaginal evisceration is a rare entity and is scarcely documented; the case of a 81-year-old patient with a history of abdominal hysterectomy, who attended the medical service after eight hours of evolution of a clinical picture characterized by pelvic pain and ejection of the large intestine (sigmoid colon) through the vaginal canal is presented here. The patient underwent an exploratory laparotomy, Hartmann colostomy, rectopexy to the promontory and restitution of traffic in a subsequent procedure; after presenting a satisfactory evolution, she was discharged.

La evisceración es la salida de vísceras abdominales a través de un orificio no natural con una incidencia entre 0.03 y 4.1%. Esta condición con frecuencia ocurre tras una histerectomía abdominal (47%), una histerectomía vaginal (29.4%) o luego de practicarse un abordaje laparoscópico (23.6%). Tiene mayor incidencia en mujeres posmenopáusicas histerectomizadas, mientras que el intervalo de tiempo entre el acto quirúrgico y la complicación puede variar de pocos días a algunos años. Por otra parte, en la mayoría de los casos, el órgano eviscerado es el intestino delgado, lo que representa una emergencia quirúrgica. Teniendo en cuenta que la evisceración transvaginal es una entidad muy rara, además de la escasa información al respecto, se presenta el caso de una paciente de 81 años, con antecedentes de histerectomía abdominal, que acudió al servicio médico por presentar ocho horas de evolución de cuadro clínico caracterizado por dolor pélvico y salida del intestino grueso (colón sigmoide) por canal vaginal. La paciente fue sometida a laparotomía exploratoria, colostomía tipo Hartmann, rectopexia a promontorio y restitución del tránsito en segundo tiempo; luego de presentar una evolución satisfactoria, fue dada de alta.

Evisceração por acidente automobilístico em cão da raça pitbull / Evisceration by car accident in dog pitbull

Foi atendido no Hospital de Clínicas Veterinária da UFRGS um canino da raça Pitbull, de aproximadamente cinco anos e pesando 40 kg. O animal apresentava evisceração de diversos órgãos abdominais devido a atropelamento, além de choque hipovolêmico.

Evisceración transvaginal / Transvaginal evisceration

Se presenta una paciente de 55 años de edad que acude al cuerpo de guardia del Hospital General Docente Dr. Carlos J. Finlay con una evisceración transvaginal con compromiso vascular. Se realizó una hemicolectomía derecha urgente con cierre intraperitoneal de la cúpula vaginal, fue egresada a los 8 días con estado de salud satisfactorio

This is the case of a female patient aged 55 seen in tht Emergency Room of Dr. Carlos J. Finlay Teaching General Hospital presenting with transvaginal evisceration and vascular involvement. A urgent right hemicolectomy was performed with intraperitoneal closure of vaginal cupula being discharged at 8 days with a satisfactory health condition

Laparoscopic nephropexy exposes a possible underlying pathogenic mechanism and allows successful treatment with tissue gluing of the kidney and fixation of the colon to the lateral abdominal wall

Objectives: Surgical treatment of "Ren Mobilis" has historically been associated with poor results and fairly high morbidity. We have used a transperitoneal laparoscopic approach in order to minimize morbidity. The goal of this study was to evaluate the success rate and to discuss the possible pathogenic mechanism, which has implications for the surgical strategy. Materials and methods: Seven women with a right mobile kidney were examined by intravenous pyelogram and CT scans. Symptoms were judged to emanate from the mobile kidney. Transperitoneal laparoscopic nephropexy was performed. The surgical treatment consisted of fixing the kidney to the dorsal abdominal wall using tissue glue (Tisseel®) after diathermy coagulation of the surfaces to induce fibrosis. The right colon was fixed with clips to the lateral abdominal wall, trapping the kidney in place. Results: In 6 of the cases, there was an incomplete rotation of the ascending colon to the right side, allowing the kidney to move freely. In one case, the kidney moved into a retroperitoneal pocket of the mesocolon. The 6 cases with a lateral passage for the kidney were symptom-free at follow-up (30-80 months), but in the 7th case the patient's kidney quickly loosened and she underwent an open reoperation, after which she was symptom-free. Conclusion: Our series demonstrates that good results can be achieved with a transperitoneal laparoscopic approach, but also indicates that there is a common pathogenic mechanism with incomplete rotation of the ascending colon that can be corrected during surgery, which might contribute to the good results.

Clinical study on concomitant surgery for stress urinary incontinence and pelvic organ prolapse / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss indications and therapeutic effects of concomitant surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) through a retrospective clinical review.</p><p><b>METHOD</b>A retrospective review of the data of 16 women undergoing concomitant surgery for SUI and POP was available for analysis. In these cases, 12 patients presented with SUI symptoms associated with moderate or severe anterior vaginal wall prolapse; 4 patients had moderate or severe uterine prolapse associated with dysuria. All cases were confirmed to have type II stress urinary incontinence by preoperative physical examination, urodynamic study and cystography. The surgical procedures for pelvic floor repair included the placement of Gynemesh mesh implant, anterior or total Prolift mesh implant. The tension-free vaginal tape (TVT) or transvaginal tension free vaginal tape-obturator (TVT-O) was used for the anti-incontinence procedure. During the concurrent surgical procedures, pelvic floor repair was performed first.</p><p><b>RESULTS</b>Followed up from 6 to 30 months, all cases got satisfactory results. After the procedure, the patients achieved complete continence without occurrence of dysuria or recurrence of POP.</p><p><b>CONCLUSIONS</b>Stress incontinence and pelvic organ prolapse share common pathophysiologic etiologies and often coexist with one another. In SUI patients with symptomatic or moderate to severe POP, concurrent POP surgery should be performed actively at the time of incontinence surgery to prevent POP exacerbation and the occurrence of dysuria; while in patients with sole POP, occult SUI should be considered, and concomitant prophylactic incontinence measures should be taken at the time of POP repair to prevent the postoperative unmasking of SUI.</p>

Eventraciones agudas de laparotomías medianas / Acute eventration of medium laparotomies

Antecedentes: Las eventraciones agudas son una de las complicaciones más frecuentes de cualquier laparotomía. Las síntesis de estas últimas se realiza por preferencias personales más que por protocolos basados en la evidencia.Objetivos: relacionar la apariencia de esta complicación con la experiencia de los residentes y el material de síntesis utilizado comparando dos de los tipos mas frecuentes de síntesis.Lugar de aplicación: Hospital polivalente de alta complejidad.Diseño: Prospectivo, Observacional.Material y Método: Fichado de 126 laparotomías medianas infraumbilicales programadas entre Enero 2002 y Enero 2005. Se dividió la población en dos grupos homogéneos según el tipo de síntesis y el año de residencia del cirujano. Grupo 1: (n = 73) dos planos de poliglactina y Polipropileno 1. Grupo 2: (n = 53) monoplano Polipropileno 1. En ambos casos en sutura continua sin cruzar, con un largo nomenos a 4 veces al de la herida.Resultados: Se identificaron 5 eventraciones agudas (4). En el grupo 1: 4/73 casos (5.4). En el 2: 1/53 casos (1.8). La infección de sitio quirúrgico (ISQ) se asoció en 3 de los 5 casos. La mortalidad fue de dos casos. Los residentes de menor experiencia tuvieron mayor índice en la aparición de esta complicación.Conclusiones: Los mayores de 60 años, con ISQ asociada tuvieron mayor predisposición para las eventraciones agudas, independientemente al tipo de síntesis o equipo quirúrgico elegido. La sutura continua en monoplano de polipropileno resultó más efectiva en la prevención de esta complicación.La aparición de las eventraciones disminuye con la experiencia del residente.

A Comparison of Different Pelvic Reconstruction Surgeries Using Mesh for Pelvic Organ Prolapse Patients

This study was carried out in order to compare the effects in different surgeries using mesh in pelvic organ prolapse patients whose leading points were C. Thirty-nine patients were categorized into 3 groups: group A pelvic reconstruction with hysterectomy; group B hysterectomy prior to pelvic reconstruction; and group C pelvic reconstruction with uterus preserved. At first visit, POP-Q stage was determined, and age, BMI, admission days, operation time, post-operative stage and complications were observed and results were analyzed and compared. All patients who were operated upon converted to stage one month following the operation, and no further change was observed except in one patient. Group admission days were not significantly different, but tended to be lower in group C. Group average operation times between 'group A and B' and 'group A and C' were statistically different. No significant difference was observed in post-operative complications between the groups, but 3 members of group A developed erosion, whereas no erosion occurred in groups B and C. Pelvic reconstruction using mesh is a highly efficient method of treating pelvic organ prolapse. Improvements in stage and post-operative complications were not significantly different in the groups. However, uteropexy showed a shorter operation time, fewer admission days, and less erosion due to mesh than conventional pelvic reconstruction with hysterectomy.

Clinical significance of gastroptosis in functional dyspepsia / 대한내과학회지

The purposes of this study were to assess the relationship between functional dyspepsia (FD) and the gastroptosis which was considered as one of the causes of FD by some physicians in Korea and to evaluate the possibility that gastroptosis was directly related to the relatively decreased abdominal fat content. METHODS: 442 subjects taken upper gastrointestinal barium series (UGIS) for routine check-up were interviewed about symptoms of FD by physicians on the basis of Rome criteria. Various parameters of obesity were also collected from 366 subjects. Gastroptosis was diagnosed by radiologists when the gastric angle was located below the Jacobys line. RESULTS: Gastroptosis was found in 23 (5.2%) of 442 subjects. Relationship between gastroptosis and FD was rejected statistically because 3 (5.8%) of 52 subjects with FD had gastroptosis but 20 (5.1%) of 390 subjects without FD also showed gastroptosis. Various parameters of obesity such as body mass index (20.6+/-2.6, 23.8+/-2.8), % body fat (23.4+/-6.1%, 28.2+/-6.6%), % ideal body weight (97.9+/-12.6%, 112.6+/-14.0%), waist to hip ratio (0.855+/-0.096, 0.900+/-0.070) and weight (53.5+/-8.2 kg, 62.5+/-9.6 kg) in subjects with and without FD showed that the gastroptosis was more frequent in subjects with low values in parameters of obesity. But on multivariate analysis, only body mass index was the independent factor related to gastroptosis. CONCLUSION: Gastroptosis is not a cause of FD but is thought to be a constitutional problem related to low values in parameters of obesity.