Dataset Information

Spontaneous transvaginal small bowel evisceration secondary to vaginal cuff dehiscence after abdominal hysterectomy: A case report.

ABSTRACT:

Introduction

and importance: Small intestinal evisceration through the vaginal canal is a rare surgical emergency that necessitates immediate surgery to avoid bowel necrosis, infection, and death. It was first documented in 1864.

Case presentation

A 55-year-old postmenopausal woman was reported to the emergency department with an 8-h history of moderate lower abdomen pain and diarrhea. After investigation, the patient was diagnosed with transvaginal small bowel evisceration, and vaginal cuff dehiscence was repaired.

Clinical discussion

Given the high death rates associated with this illness, we publish this case to promote awareness of therapeutic techniques. Second, it highlights the significance of interdisciplinary surgical collaboration in achieving the greatest possible patient outcome.

Conclusion

An operation should be performed to avoid significant complications such as peritonitis, sepsis, and septic shock, considering the disease's rarity and high fatality rate if not treated early.

SUBMITTER: Mohamed Salad N

PROVIDER: S-EPMC9289328 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Spontaneous transvaginal small bowel evisceration secondary to vaginal cuff dehiscence after abdominal hysterectomy: A case report.

Mohamed Salad Najib N Ali Omar Abdikarim A Mohamed Yahye Garad YG

Annals of medicine and surgery (2012) 20220614

<h4>Introduction</h4>and importance: Small intestinal evisceration through the vaginal canal is a rare surgical emergency that necessitates immediate surgery to avoid bowel necrosis, infection, and death. It was first documented in 1864.<h4>Case presentation</h4>A 55-year-old postmenopausal woman was reported to the emergency department with an 8-h history of moderate lower abdomen pain and diarrhea. After investigation, the patient was diagnosed with transvaginal small bowel evisceration, and v ...[more]

PMID: 35860117

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Project description:OBJECTIVE:To compare the effects of laparoscopic hysterectomy and abdominal hysterectomy in the abdominal trial, and laparoscopic hysterectomy and vaginal hysterectomy in the vaginal trial. DESIGN:Two parallel, multicentre, randomised trials. SETTING:28 UK centres and two South African centres. PARTICIPANTS:1380 women were recruited; 1346 had surgery; 937 were followed up at one year. Primary outcome Rate of major complications. RESULTS:In the abdominal trial laparoscopic hysterectomy was associated with a higher rate of major complications than abdominal hysterectomy (11.1% v 6.2%, P = 0.02; difference 4.9%, 95% confidence interval 0.9% to 9.1%) and the number needed to treat to harm was 20. Laparoscopic hysterectomy also took longer to perform (84 minutes v 50 minutes) but was less painful (visual analogue scale 3.51 v 3.88, P = 0.01) and resulted in a shorter stay in hospital after the operation (3 days v 4 days). Six weeks after the operation, laparoscopic hysterectomy was associated with less pain and better quality of life than abdominal hysterectomy (SF-12, body image scale, and sexual activity questionnaires). In the vaginal trial we found no evidence of a difference in major complication rates between laparoscopic hysterectomy and vaginal hysterectomy (9.8% v 9.5%, P = 0.92; difference 0.3%, -5.2% to 5.8%), and the number needed to treat to harm was 333. We found no evidence of other differences between laparoscopic hysterectomy and vaginal hysterectomy except that laparoscopic hysterectomy took longer to perform (72 minutes v 39 minutes) and was associated with a higher rate of detecting unexpected pathology (16.4% v 4.8%, P = < 0.01). However, this trial was underpowered. CONCLUSIONS:Laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy. It also took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life. The trial comparing vaginal hysterectomy with laparoscopic hysterectomy was underpowered and is inconclusive on the rate of major complications; however, vaginal hysterectomy took less time.

Project description:ImportanceSpontaneous preterm birth is a leading cause of infant mortality. Prediction, largely based on prior pregnancy outcomes, is not possible in women pregnant for the first time.ObjectiveTo assess the accuracy of universal screening to predict spontaneous preterm birth in nulliparous women using serial measurements of vaginal fetal fibronectin levels and cervical length.Design, settings, and participantsA prospective observational cohort study of nulliparous women with singleton pregnancies, from 8 clinical sites across the United States between October 2010 and May 2014. Women and clinicians were blinded to results unless cervical shortening less than 15 mm was identified.ExposuresTransvaginal cervical length and quantitative vaginal fetal fibronectin levels were reviewed at 2 study visits 4 or more weeks apart.Main outcomes and measuresSpontaneous preterm birth at less than 37 weeks was the primary outcome. Cervical length and quantitative fetal fibronectin were considered independently and together at each visit. Measurement distributions were compared for spontaneous preterm birth vs all other births. Spontaneous preterm birth before 32 weeks was a secondary outcome.ResultsThe study included 9410 women (median age, 27.0 [interquartile range, 9.0] years; 60.7% non-Hispanic white, 13.8% non-Hispanic black, 16.5% Hispanic, 4.0% Asian, and 5.1% other), of whom 474 (5.0%) had spontaneous preterm births, 335 (3.6%) had medically indicated preterm births, and 8601 (91.4%) had term births. Among women with spontaneous preterm birth, cervical length of 25 mm or less occurred in 35 of 439 (8.0%) at 16 to 22 weeks' gestation and in 94 of 403 (23.3%) at 22 to 30 weeks' gestation. Fetal fibronectin levels of 50 ng/mL or greater at 16 to 22 weeks identified 30 of 410 women (7.3%) with spontaneous preterm birth and 31 of 384 (8.1%) at 22 to 30 weeks. The area under the receiver operating characteristic curve for screening between 22 and 30 weeks for fetal fibronectin level alone was 0.59 (95% CI, 0.56-0.62), for transvaginal cervical length alone was 0.67 (95% CI, 0.64-0.70), and for the combination as continuous variables was 0.67 (95% CI, 0.64-0.70).Conclusions and relevanceAmong nulliparous women with singleton pregnancies, quantitative vaginal fetal fibronectin and serial transvaginal ultrasound cervical length had low predictive accuracy for spontaneous preterm birth. These findings do not support routine use of these tests in such women.

Project description:BackgroundThe aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH).MethodsThis two-centre, randomized-controlled study included a total of 160 patients who were scheduled for TLH for benign diseases (ClinicalTrials.gov Identifier is NCT05080114 and the first posted date was 15/10/2021). The patients were allocated into two groups by a computer-based randomization programme as ST group and MT group. Total operative time, cuff closure time, length of hospital stay, intra- and postoperative complications according to the Clavien-Dindo classification, pre- and postoperative vaginal length, and patient satisfaction according to the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed.ResultsSeventy-seven patients in the ST group and 80 patients in the MT group underwent TLH. The total operative time was significantly shorter in the MT compared to the ST (55.5 vs. 59 min, respectively; p = 0.001). The median total operative time for colpotomy, extraction of uterus, and vaginal cuff closure steps was 9 (range 6-12 in MT vs. 6 to 11 in ST) min in both groups. The median hospital stay was 2 (range 1-4) days in both groups. Intraoperative blood loss was not significantly different between the groups (90 mL in ST vs. 80 mL in MT; p = 0.456). The mean uterine weight for the ST group and MT group was comparable (258.6 ± 88.6 g vs. 232.9 ± 102.5 g, respectively; p = 0.107). The preoperative vaginal length was not significantly different between the groups (p = 0.502). The median postoperative vaginal length was significantly higher in the MT group compared to the ST group on Day 90 (8 cm vs. 7,5 cm, respectively; p = 0.001). The PGI-I questionnaire score on Day 90 postoperatively was 2 (range 1-5) in both groups (p = 0.636). The complication rates were similar between the groups (p = 0.230).ConclusionThe MT can be safely performed in most of the cases requiring TLH with the advantages of vaginal cuff closure before the alteration of pelvic anatomy, support to primary healing of the vaginal cuff, and routine concomitant apical support.

Dataset Information

Spontaneous transvaginal small bowel evisceration secondary to vaginal cuff dehiscence after abdominal hysterectomy: A case report.

Introduction

Case presentation

Clinical discussion

Conclusion

Publications

Spontaneous transvaginal small bowel evisceration secondary to vaginal cuff dehiscence after abdominal hysterectomy: A case report.

Similar Datasets

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