RESUMO
We present a case of a 26-year-old woman with a small bowel herniating from her vagina following traumatic injury from a road traffic accident. The patient was taken immediately to operating theatre for repair of her uterine defect and small bowel resection. The patient required eventual return to theatre for subtotal hysterectomy and recovered well after her surgeries. She was discharged home without any further complications and in good condition.
Assuntos
Hérnia/diagnóstico , Herniorrafia , Histerectomia , Intestino Delgado/cirurgia , Vagina/cirurgia , Prolapso Visceral/cirurgia , Acidentes de Trânsito , Adulto , Países em Desenvolvimento , Feminino , Humanos , Intestino Delgado/lesões , Intestino Delgado/patologia , Resultado do Tratamento , Prolapso Visceral/diagnóstico , Prolapso Visceral/patologiaAssuntos
Histerectomia/efeitos adversos , Intestino Delgado , Prolapso Visceral , Idoso de 80 Anos ou mais , Tratamento de Emergência/métodos , Feminino , Humanos , Histerectomia/métodos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Exame Físico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Resultado do Tratamento , Prolapso Visceral/diagnóstico , Prolapso Visceral/etiologia , Prolapso Visceral/fisiopatologia , Prolapso Visceral/cirurgiaRESUMO
Gastrointestinal complications are common in patients with Ehlers-Danlos syndrome, affecting up to 50% of individuals depending on the subtype. The spectrum of gastrointestinal manifestations is broad and ranges from life threatening spontaneous perforation of the visceral organs to a more benign functional symptoms. Here we describe the clinical and radiographic manifestations of visceroptosis of the bowel, a rare complication of Ehlers-Danlos syndrome that is characterized by prolapse of abdominal organs below their natural position. We further review the literature on gastrointestinal complications in the different forms of Ehlers-Danlos syndrome.
Assuntos
Síndrome de Ehlers-Danlos/complicações , Prolapso Visceral/diagnóstico , Prolapso Visceral/etiologia , Adulto , Feminino , Humanos , Trato Gastrointestinal Inferior/diagnóstico por imagem , Radiografia , Trato Gastrointestinal Superior/diagnóstico por imagem , Prolapso Visceral/diagnóstico por imagemRESUMO
BACKGROUND: Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction. OBJECTIVE: We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence. CASE REPORT: A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room. CONCLUSION: Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.
Assuntos
Obstrução Intestinal/etiologia , Prolapso Uterino/complicações , Prolapso Visceral/etiologia , Idoso , Feminino , Humanos , Obstrução Intestinal/cirurgia , Intestino Delgado , Retocele/complicações , Fatores de Risco , Prolapso Uterino/cirurgia , Prolapso Visceral/diagnóstico , Prolapso Visceral/cirurgiaRESUMO
Pelvic organ prolapse is prevalent among older women. Milder stages of prolapse, cranial to the hymen, are common and usually symptomless. A specific symptom is a bulge outside the vagina. Functional symptoms from the bladder, bowel and sexual life frequently coexist without a known cause/effect relationship to prolapse. Prolapse should be measured by the validated internationally approved pelvic organ prolapse quantification (POPQ) system that can measure prolapse in the three compartments and three levels of the vagina. We should work on a common classification system and agreement in which symptoms should be recorded as related to prolapse and expected to improve by prolapse surgery.
Assuntos
Prolapso Uterino/classificação , Prolapso Visceral/classificação , Coito/psicologia , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Feminino , Humanos , Diafragma da Pelve/anatomia & histologia , Prevalência , Prolapso , Retocele/etiologia , Doenças da Bexiga Urinária/classificação , Incontinência Urinária/etiologia , Incontinência Urinária/terapia , Prolapso Uterino/diagnóstico , Útero/anatomia & histologia , Útero/patologia , Vagina/anatomia & histologia , Vagina/patologia , Prolapso Visceral/diagnósticoRESUMO
Internal iliac artery aneurysms (IIAAs) are rare and their concealed location in the pelvis presents a diagnostic challenge. We report a case of a 79-year-old man who presented 12 years after an abdominal aortic aneurysm repair, with signs of prolapse, bleeding, hemorrhoids, and a deep vein thrombosis. His condition rapidly deteriorated, with the development of acute renal failure and obvious perianal and perineal ecchymoses, within a few days. Abdominal ultrasound and computed tomography showed a ruptured IIAA. His renal function returned to normal after surgical decompression of the aneurysm.
Assuntos
Aneurisma Roto/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Hemorroidas/diagnóstico , Artéria Ilíaca/cirurgia , Prolapso Visceral/diagnóstico , Idoso , Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Diagnóstico Diferencial , Seguimentos , Hemorroidas/cirurgia , Humanos , Masculino , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler , Prolapso Visceral/cirurgiaAssuntos
Doenças do Tecido Conjuntivo/diagnóstico , Adolescente , Adulto , Cromossomos Humanos Par 15 , Doenças do Tecido Conjuntivo/genética , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/genética , Feminino , Ligação Genética , Cardiopatias/diagnóstico , Cardiopatias/genética , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/genética , Pessoa de Meia-Idade , Pneumotórax/diagnóstico , Proteinúria/diagnóstico , Síndrome , Prolapso Visceral/diagnósticoRESUMO
Torsion of the pedicle of a visceroptosed spleen, a rare condition, was diagnosed preoperatively in a 4-year-old girl, with the aid of history, physical examination, blood smear findings, splenic scans with technetium Tc 99m sulfur colloid, and selective angiography. A splenectomy was performed, and the child made an uneventful recovery. This case report illustrates some of the diagnostic and therapeutic considerations pertaining to torsion of the spleen.