Vaginal small bowel evisceration following total abdominal hysterectomy.

Background: Evisceration following hysterectomy is so rare that no incidence rate can be established. It usually occurs in postmenopausal or multiparous women, after one or more vaginal operations. Most often the precipitating event for small bowel evisceration is sexual intercourse in premenopausal women, and increased intra-abdominal pressure in postmenopausal women. Case report: We report a case of transvaginal evisceration after abdominal hysterectomy, which occurred twice in the same woman, this being the first case of its kind reported in the literature so far. Conclusions: Vaginal evisceration represents a life-threatening surgical emergency which must be promptly treated and the surgical approach may be either abdominal or vaginal or a combination of the two. Management is directed toward resecting any comprised bowel loops, repairing the vaginal defect and correcting the contributing defect in the pelvic floor.