Archives of Medicine and Health Sciences

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

Abdominal ultrasound depicting vaginal evisceration of bowel


Vinayak Jain1, Akhila Vasudeva2,  
1 Intern, KMC, MAHE, Manipal, Karnataka, India
2 OBG, Kasturba Medical College, MAHE, Manipal, Karnataka, India

Correspondence Address:
Vinayak Jain
505 Pratham Pride, End Point Road, Manipal - 576 104, Karnataka
India

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.



How to cite this article:
Jain V, Vasudeva A. Abdominal ultrasound depicting vaginal evisceration of bowel.Arch Med Health Sci 2021;9:357-358


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 Aug 20 ];9:357-358
Available from: https://www.amhsjournal.org/text.asp?2021/9/2/357/334012


Full Text



 Case Report



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}

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

1Rogers P, Lee H, Jape K, Ng ZQ, Koong D. Vaginal evisceration of small bowel. J Surg Case Rep 2019;2019:rjz317.
2Virtanen 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.
3Wiafe 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.