-Case Reports-

Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review

Tomohiko Matsuhashi¹, Kazuho Nakanishi¹, Eri Hamano¹, Seiryu Kamoi¹ and Toshiyuki Takeshita²

¹Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
²Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan

Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred.
Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess.

J Nippon Med Sch 2017; 84: 90-95

Keywords
vaginal cuff dehiscence, evisceration, laparoscopic surgery, complication, uterine corpus cancer

Correspondence to
Tomohiko Matsuhashi, MD, PhD, Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan
t-matsuhashi@nms.ac.jp

Received, October 20, 2016
Accepted, January 10, 2017