Date of Presentation

5-2-2019 12:00 AM

Embargo Period

11-2-2019

College

School of Osteopathic Medicine

Poster Abstract

SOMETHING HAS FALLEN: PELVIC ORGAN PROLAPSE OR VAGINAL CUFF DEHISCENCE AND EVISCERATION? A CASE REPORT.

Learning Objectives: 1) Recognize late presenting complications of hysterectomy. 2) Include vaginal cuff dehiscence with evisceration (VCDE) in the differential diagnosis of women suspected of having acute pelvic organ prolapse (POP).3) Appreciate the relative rarity of VCDE in younger women.

Case Summary: A 36 year old G0P0 female presented to the ED with a chief complaint of sudden onset excruciating epigastric pain, followed by diarrhea and visible vaginal bulge. Pertinent past medical and surgical history includes breast cancer diagnosed 15 months prior, status post bilateral mastectomy, radiation, chemotherapy, and robotic-assisted prophylactic hysterectomy and BSO 6 months prior. Relevant social history includes tobacco use and first postoperative coitus 2 days prior. CT abdomen/pelvis findings included microscopic pneumoperitoneum, pelvic organ prolapse, prolapse of bowel loops into the vaginal vault, and localized small bowel obstruction. In the ED she was diagnosed with POP, which was reduced, leading to a reduction in her pain. Subsequent examination revealed an abdomen tender to palpation. Speculum exam displayed no pelvic organ prolapse. Bowel was visible at the vaginal cuff with clear yellow fluid pooling in the vaginal vault. Vesicovaginal fistula was ruled out and VCDE was suspected. During exploratory laparoscopy, a 4 cm vaginal cuff defect was found and transvaginal cuff closure was performed. Post-operative course was uncomplicated, and the patient was discharged on POD #2.


Keywords

vaginal cuff dehiscence, hysterectomy, pelvic organ prolapse

Disciplines

Female Urogenital Diseases and Pregnancy Complications | Medicine and Health Sciences | Obstetrics and Gynecology | Surgery | Urogenital System

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May 2nd, 12:00 AM

Something has Fallen: Pelvic Organ Prolapse or Vaginal Cuff Dehiscence and Evisceration? A Case Report.

SOMETHING HAS FALLEN: PELVIC ORGAN PROLAPSE OR VAGINAL CUFF DEHISCENCE AND EVISCERATION? A CASE REPORT.

Learning Objectives: 1) Recognize late presenting complications of hysterectomy. 2) Include vaginal cuff dehiscence with evisceration (VCDE) in the differential diagnosis of women suspected of having acute pelvic organ prolapse (POP).3) Appreciate the relative rarity of VCDE in younger women.

Case Summary: A 36 year old G0P0 female presented to the ED with a chief complaint of sudden onset excruciating epigastric pain, followed by diarrhea and visible vaginal bulge. Pertinent past medical and surgical history includes breast cancer diagnosed 15 months prior, status post bilateral mastectomy, radiation, chemotherapy, and robotic-assisted prophylactic hysterectomy and BSO 6 months prior. Relevant social history includes tobacco use and first postoperative coitus 2 days prior. CT abdomen/pelvis findings included microscopic pneumoperitoneum, pelvic organ prolapse, prolapse of bowel loops into the vaginal vault, and localized small bowel obstruction. In the ED she was diagnosed with POP, which was reduced, leading to a reduction in her pain. Subsequent examination revealed an abdomen tender to palpation. Speculum exam displayed no pelvic organ prolapse. Bowel was visible at the vaginal cuff with clear yellow fluid pooling in the vaginal vault. Vesicovaginal fistula was ruled out and VCDE was suspected. During exploratory laparoscopy, a 4 cm vaginal cuff defect was found and transvaginal cuff closure was performed. Post-operative course was uncomplicated, and the patient was discharged on POD #2.


 

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