A CASE OF VAGINAL VAULT DEHISCENCE WITH SMALL BOWEL EVISCERATION FOLLOWING TOTAL ABDOMINAL HYSTERECTOMY

Vaginal vault dehiscence is a rare but potential morbid complication of hysterectomy. The reported incidence of cuff dehiscence after a hysterectomy varies according to the surgical approach. The rate is higher after laparoscopic hysterectomy (0.79 to 1.5 percent) compared with abdominal (0.1 to 0.26 percent) or vaginal hysterectomy(0.08 to 0.25 percent). After dehiscence of the vaginal cuff, abdominal or pelvic contents may be expelled through the vaginal opening. Bowel evisceration can lead to serious sequelae, including peritonitis, bowel injury and necrosis, and sepsis. Prompt surgical and medical intervention are required to prevent such complications and it is a surgical emergency. We describe a case of 40 yrs old female with recent history of abdominal hysterectomy presenting to us with prolapse of a 15-20 cm loop of small intestine. The patient successfully underwent laporotomy with repositioning of the prolapsed intestinal loops into abdominal cavity with mesenteric tear repair and vault closure.