Introduction: Transvaginal small bowel evisceration is a rare surgical emergency, first reported in 1864; Is a rare but life-threatening complication, typically occurring in the acute postoperative period after hysterectomy. Its incidence is estimated at 0.28%, with risk factors including advanced age, obesity, chronic constipation, and previous pelvic surgery. Fewer than 100 cases have been reported in the literature, and this condition in postmenopausal women is more common. Cases occurring more than a decade after hysterectomy are exceedingly rare. The terminal ileum is usually the organ that protrudes through the vagina, but other organs such the colon , omentum and the appendix have also been reported to be involved. The common symptoms include the sense of a tissue protruding through the vagina, pain, bleeding and discharge, and the most dramatic presentation of this pathology documented is a large loop of small bowel prolapse through the vagina.

Case Presentation:We report the case of a 62-year-old woman who presented with transvaginal evisceration of the small bowel 10 years after undergoing a total abdominal hysterectomy.

The event occurred suddenly while straining during defecation. Physical examination revealed an intestinal loop protruding through the vaginal vault without ischemia or necrosis. Emergency laparotomy was performed, involving peritoneal lavage and closure of the vaginal cuff defect. The patient had an uneventful postoperative recovery.

Discussion:Most cases of transvaginal evisceration occur within months to a few years after hysterectomy, with median times ranging from 3 months for laparoscopic hysterectomy to 34 months for vaginal hysterectomy. Evisceration occurring after 10 years is exceptionally rare, with only isolated reports in the literature. Chronic risk factors such as constipation and increased intra-abdominal pressure may contribute to late presentations. Prompt surgical intervention is critical to prevent bowel ischemia and sepsis.

Conclusion:This case highlights the importance of considering transvaginal evisceration as a differential diagnosis even in delayed presentations post-hysterectomy. Awareness of risk factors and timely surgical management are essential to ensure favorable outcomes.

Salad NM, Omar AA, Mohamed YG. Spontaneous transvaginal small bowel evisceration secondary to vaginal cuff dehiscence after abdominal hysterectomy: a case report. Ann Med Surg (Lond). 2022;79:104024.
Missori G, Marchesini NLA, Mosca D, Ricciardolo AA, Serra F, Gelmini R. Vaginal evisceration of small bowel with extraperitoneal ileal resection of the herniated loops: a case report. Front Surg. 2022;9:878760.
Kountouri I, Giotas A, Gkogkos C, Katsarelas I, Nachopoulos P, Faseki A, et al. Spontaneous transvaginal small bowel evisceration after laparoscopic hysterectomy. Diagnostics (Basel). 2024;14(22):2498.