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 Table of Contents  
TEACHING IMAGES
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 357-358

Abdominal ultrasound depicting vaginal evisceration of bowel


1 Intern, KMC, MAHE, Manipal, Karnataka, India
2 OBG, Kasturba Medical College, MAHE, Manipal, Karnataka, India

Date of Submission20-Sep-2021
Date of Decision07-Oct-2021
Date of Acceptance08-Oct-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Vinayak Jain
505 Pratham Pride, End Point Road, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_248_20

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  Abstract 


Vaginal evisceration represents the extreme outcome of intestinal prolapse following iatrogenic uterine perforation. It is a rare occurrence and considered a surgical emergency with a mortality rate of 6%. The whole track is rarely seen in abdominal ultrasound. Ultrasound is the least expensive, easily available imaging tool, which may clearly show the track of perforation. Timely detection prevents deadly sequelae.

Keywords: Dilatation and curettage, ultrasound, uterine perforation, vaginal evisceration


How to cite this article:
Jain V, Vasudeva A. Abdominal ultrasound depicting vaginal evisceration of bowel. Arch Med Health Sci 2021;9:357-8

How to cite this URL:
Jain V, Vasudeva A. Abdominal ultrasound depicting vaginal evisceration of bowel. Arch Med Health Sci [serial online] 2021 [cited 2022 Jan 22];9:357-8. Available from: https://www.amhsjournal.org/text.asp?2021/9/2/357/334012




  Case Report Top


We report the case of a 22-year-old female who underwent surgical evacuation following missed abortion at 8 weeks. Procedure was abandoned due to suspected uterine perforation, and she was referred to us for further management. The patient was clinically stable but complained of abdominal pain. Abdomen was soft and nontender. Local examination revealed a tampon packed in the vagina and minimal bleeding. Transabdominal ultrasound [Figure 1] revealed anechoic tubular structure (suggestive of bowel loop) tracking through the fundus, uterine wall, uterine cavity, and posterior myometrial rent all the way into the vagina. Emergency laparotomy revealed a 15-cm loop of gangrenous small bowel herniating through a rent in the posterior uterus into the vagina [Figure 1]. The affected portion was resected and end-to-end anastomosis was done. Postoperatively, the patient was monitored closely and recovery was uneventful.
Figure 1: Left side: Trans-abdominal ultrasound (A: Small bowel, B: Posterior myometrium, C: Bladder, D: Vagina, dashed lines: Track of small bowel). Right side: Intra-operative finding (E: Gangrenous bowel loop coming out of posterior uterine rent).

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Vaginal evisceration represents the extreme outcome of intestinal prolapse following iatrogenic uterine perforation. It is a rare occurrence and considered a surgical emergency with a mortality rate of 6%.[1],[2] It is suspected only with features of intestinal gangrene, perforation, and sepsis. The whole track is rarely seen in abdominal ultrasound. To the best of our knowledge, only two such Ultrasonography (USG) images have been reported in the literature so far by the same author.[3] Ultrasound is the least expensive, easily available imaging tool, which may clearly show the track of perforation. Timely detection prevents deadly sequelae such as bowel injury, peritonitis, necrosis, or sepsis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rogers P, Lee H, Jape K, Ng ZQ, Koong D. Vaginal evisceration of small bowel. J Surg Case Rep 2019;2019:rjz317.  Back to cited text no. 1
    
2.
Virtanen HS, Ekholm E, Kiilholma PJ. Evisceration after enterocele repair: A rare complication of vaginal surgery. Int Urogynecol J Pelvic Floor Dysfunct 1996;7:344-7.  Back to cited text no. 2
    
3.
Wiafe YA, Anyitey-Kokor I, Agyei BA, Appiah-Kubi A, Owusu-Asubonteng G. Sonographic detection of uterine perforation in surgical abortions: Case report from a developing country. Med Res Arch 2019;7:1-9.  Back to cited text no. 3
    


    Figures

  [Figure 1]



 

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