Spontaneous Transvaginal Intestinal Evisceration Two Years after Vaginal Hysterectomy, a Case Report.

Vaginal evisceration is an exceedingly rare and poorly documented complication following vaginal hysterectomy. Prompt detection and surgical intervention are critical to prevent severe complications such as bowel ischemia, perforation, and secondary sepsis. We present the case of an 84-year-old woman with a history of vaginal hysterectomy two years prior, who presented with acute abdominal pain and a significant portion of her small bowel protruding through a defect in the vaginal vault. The patient was urgently transferred to the operating room, where the loops of the small bowel were manually reduced through the vaginal defect. As the bowel appeared viable, no resection was required. The etiology of this condition is unclear and likely multifactorial. Various surgical approaches, including laparoscopic, abdominal, transvaginal, and combined techniques, have been described, all offering comparable outcomes. Therefore, the choice of surgical procedure should be tailored to the patient's clinical presentation.

Laparoscopic insertion of pelvic tissue expander prior radiotherapy for sacral metastasis of alveolar maxillary rhabdomyosarcoma to prevent radiation enteritis.

INTRODUCTION: Rhabdomyosarcoma is the most common soft tissue sarcoma seen in childhood and adolescence. The most frequent sites are head and neck. PRESENTATION OF CASE: A young female with maxillary rhabdomyosarcoma involving region of maxillary sinus with skeletal metastases was primary treated acccording to RMS 2005 protocol. She received 9 cycles of chemotherapy. Primary tumor of maxillary sinus was surgicaly removed after 4 cycles of chemotherapy, with 6th cycle of chemotherapy a radical radiotherapy of primary tumor location and metastasis in spinal vertebras, ribs, pelvic bone and left femoral bone started what leads to complete regression of skeletal metastases. In course of maintenance therapy MRI scan showed 12 × 28 × 23 mm lesion in sacrum in the vicinity of right sacroiliacal joint with caracteristics of metastasis. Because the region of right sacroiliacal joint with bowel was already included in primary radiation treatment, tissue expander was laparoscopicaly inserted in lower pelvis to displace bowel loops from radiation field to prevent radiation enteritis. After external beam radiotherapy to her sacrum, a good response without any side effects was achieved. DISCUSSION: Laparoscopic insertion of pelvic tissue expander prior EBRT and it's subsequent removal after EBRT is safe and effective method for displacing loops of bowel out of the pelvis. With minimal morbidity converts untreatable disease to treatable by allowing delivering high doses of radiation to the patient. CONCLUSION: After 2 years of follow up the disease is in remission and the patient without any major complaint.