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Medline ® Abstract for Reference 16

of 'Vaginal cuff dehiscence after hysterectomy'

Vaginal evisceration: presentation and management in postmenopausal women.
Kowalski LD, Seski JC, Timmins PF, Kanbour AI, Kunschner AJ, Kanbour-Shakir A
J Am Coll Surg. 1996;183(3):225.
BACKGROUND: Vaginal evisceration is a rare event, often associated with previous vaginal surgery in postmenopausal women. To date, 57 cases have been described in the world literature since 1901.
STUDY DESIGN: We report three cases of vaginal evisceration and review risk factors and management described in the current literature.
RESULTS: Of 60 reported cases of vaginal evisceration, 41 occurred in postmenopausal women. A common triad of previous vaginal surgery (73 percent), postmenopausal status (68 percent), and the presence of an enterocele (63 percent) was identified. Histopathologic evaluation of one case revealed a chronic vaginal-peritoneal fistula, and immunohistochemistry highlighted migration of squamous cells to multiple peritoneal serosal surfaces. This finding emphasizes the chronic nature of factors that predispose to the acute evisceration of abdominal contents. Most eviscerations were managed by primary repair of the vaginal disruption and the accompanying disorder of the pelvic floor, after assessing the viability of the prolapsed bowel and resecting anycompromised segments. However, most surgeons agreed that delayed vaginal repair was preferable if the vaginal tissues appeared acutely inflamed or nonviable.
CONCLUSIONS: Vaginal evisceration is primarily seen with obstetrical or postcoital trauma, but in postmenopausal women it is most often associated with a history of vaginal surgery and a pelvic support disorder. Hypoestrogenism, atrophy, and devascularization from previous surgery seem to play a significant role. Management is directed toward resecting any compromised bowel, repairing the vaginal defect, and correcting the contributing defect in the pelvic floor.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Health Sciences Center, Magee-Womens Hospital, PA, USA.