Tardive transvaginal small bowel evisceration after colpohysterectomy: a case report of a rare surgical emergency

Transvaginal small bowel evisceration is a rare surgical emergency after gynaecological surgery with around 100 cases described in literature from 1864. Its diagnosis is merely clinical. The surgical treatment is time-depending because of the risk of acute small bowel ischemia. A 71-year-old female presented in our emergency room complaining abdominal pain, vomiting, and small bowel evisceration through the vagina. She suffered gynaecological prolapse and underwent transvaginal hysterectomy four years earlier. At the clinical examination, intestinal loops were oedematous, dusky, vascular sufferance, and without peristalsis. An urgent laparotomy was performed to reduce the prolapsed bowel, resect the ischemic loop, and vaginal cuff closure. Transvaginal bowel evisceration is a delay complication after hysterectomy. It is a life-threatening condition that requires prompt recognition and surgical management.