A Laparoscopic Approach to Postcoital Vaginal Perforation in an Adolescent with Peritonitis and Hypovolemic Shock

Vaginal laceration during coitus is not a rare occurrence; however, vaginal perforation from coitus is uncommon and occurs in less than 1% of nonobstetric genital tract injuries. Limited case reports exist discussing the recognition and management of vaginal perforation. Previously described managem...

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Bibliographic Details
Published in:Journal of pediatric & adolescent gynecology 2020-10, Vol.33 (5), p.594-598
Main Authors: Cohen, Alexa, Ulrich, Amanda, Semenyuk, Natalie
Format: Article
Language:English
Subjects:
Adolescent
Coitus
Female
Hemorrhage - etiology
Humans
Intercourse
Lacerations - diagnosis
Lacerations - etiology
Lacerations - pathology
Lacerations - surgery
Laparoscopy
Laparoscopy - methods
Male
Peritonitis - etiology
Pneumoperitoneum - diagnostic imaging
Pneumoperitoneum - etiology
Pneumoperitoneum - pathology
Shock - etiology
Shock - surgery
Vagina - injuries
Vaginal perforation
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Summary:Vaginal laceration during coitus is not a rare occurrence; however, vaginal perforation from coitus is uncommon and occurs in less than 1% of nonobstetric genital tract injuries. Limited case reports exist discussing the recognition and management of vaginal perforation. Previously described management is commonly performed with laparotomy. We report a case of postcoital vaginal laceration and posterior fornix perforation in an adolescent with hemoperitoneum, pneumoperitoneum, and subsequent hypovolemic shock, and describe a laparoscopic approach for repair. Vaginal perforation with subsequent peritonitis and hemodynamic instability is a rare outcome in an adolescent who presents to the emergency department with pain or bleeding in the setting of recent penile intercourse. Delays in recognition can lead to further patient compromise, with potential morbidity or mortality. In this patient cohort, we suggest maintaining a high clinical suspicion for this sequela, and a low threshold for surgery with perforations greater than 1 cm. In the event that surgical management is warranted, we recommend a laparoscopic approach to increase visibility and to improve postoperative outcomes.
ISSN:1083-3188
1873-4332
DOI:10.1016/j.jpag.2020.05.001