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.

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.

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.