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Case Reports in Obstetrics and Gynecology
Volume 2014, Article ID 257398, 4 pages
http://dx.doi.org/10.1155/2014/257398
Case Report

Vaginal Treatment of Vaginal Cuff Dehiscence with Visceral Loop Prolapse: A New Challenge in Reparative Vaginal Surgery?

Department of Obstetrics and Gynecology, School of Medicine, University Hospital Policlinico of Bari and University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy

Received 3 September 2014; Accepted 17 November 2014; Published 24 November 2014

Academic Editor: Stefan P. Renner

Copyright © 2014 Salvatore Andrea Mastrolia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy and refers to separation of the vaginal cuff closure. The term vaginal cuff dehiscence is frequently interchanged with the terms of cuff separation or cuff rupture. All denote the separation of a vaginal incision that was previously closed at time of total hysterectomy. After dehiscence of the vaginal cuff, abdominal or pelvic contents may prolapse through the vaginal opening. Bowel evisceration, outside the vulvar introitus, can lead to serious sequelae, including peritonitis, bowel injury and necrosis, or sepsis. Therefore, although prompt surgical and medical intervention is required to replace prolapsed structures, the main problem remains the reconstruction of vaginal vault. In case of recent hysterectomy, vaginal reparation only requires the approximation of vaginal walls, including their fascia, while if dehiscence occurs after a long time from hysterectomy, the adequate suspension of the vaginal vault has to be taken into consideration. In this report we describe the case of a postmenopausal patient, undergoing surgical emergency because of the evisceration of an intestinal loop through a dehiscence of vaginal vault, after numerous reconstructive vaginal surgeries for vaginal prolapse. This paper analyzes clinical circumstances, risk factors, comorbidity, and clinical and surgical management of this complication.