Spontaneous transvaginal bowel evisceration
A 51-year-old postmenopausal female presented to the emergency department with complaints of continuous, dull aching pain in the lower abdomen and an irreducible mass protruding per vagina for the past 6 hours. Patient's past history was significant for high-grade muscle invasive transitional carcinoma of bladder. She underwent anterior pelvic excentration with ileal conduit 3 months back. Histopathology reported high-grade papillary urothelial carcinoma with muscle and urethral invasion without involvement of the ureters. There was no lymph node metastasis. Postoperative period was uneventful.\nAt the current visit, general survey showed features suggestive of dehydration with pulse rate of 94/min and blood pressure recording of 130/88 mm of Hg. On examination, about 30 cms of small bowel was found protruding through the vaginal introitus []. The bowel loops were congested and a small defect was palpable in the pelvic floor communicating with the peritoneal cavity. Systemic examination was completely normal. Abdominal examination showed ileostomy site draining clear urine, midline incision healed by primary intension. Hematological and biochemical investigations were normal. Exploratory laparotomy was done after stabilizing the patient which showed 30 cms of jejunal and ileal loops prolapsing through pelvic floor and vaginal introitus. Bowel loops were congested but found to be viable after reduction into peritoneal cavity. Full-thickness tear was present in jejunal loop 25 cms from duodeno-jejunal flexure; resection anastamosis was hence performed. Pelvic floor was repaired with prolene mesh and vagina closed from the perineum. Postoperatively patient had uneventful recovery. Follow-up after 1 month was normal.