“It just wasn’t right down there”: Surgical treatment of small bowel evisceration after hysterectomy with indocyanine green angiography, a case report

This is a case of a 70-year-old female with small bowel evisceration through vaginal cuff dehiscence 14 months after hysterectomy. She presented with a loop of ileum herniated through the vagina. The bowel was irreducible and she was taken to the operating room for exploratory laparotomy, reduction...

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Bibliographic Details
Published in:SAGE open medical case reports 2024-01, Vol.12, p.2050313X231222211
Main Authors: Spann, Jane E, Kallas, Thurston, Copperwheat, Kenneth H, Connolly, Mark M
Format: Article
Language:English
Subjects:
Case Report
Hysterectomy
Medical imaging
Vagina
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Summary:This is a case of a 70-year-old female with small bowel evisceration through vaginal cuff dehiscence 14 months after hysterectomy. She presented with a loop of ileum herniated through the vagina. The bowel was irreducible and she was taken to the operating room for exploratory laparotomy, reduction of herniated bowel contents, and repair of vaginal cuff. During surgery, the eviscerated bowel had questionable viability and indocyanine green angiography was used to assess perfusion. After the repair of the vaginal cuff, indocyanine green angiography was performed and the bowel was saved from resection. In the discussion, light is shed upon the rarity of vaginal cuff dehiscence and the few cases of small bowel evisceration after a dehiscence. Possible causes of the evisceration, updates to technique, and recommendations for management are also discussed. The ultimate recommendation is for use of indocyanine green angiography in assessment of intestinal viability during surgical exploration for small bowel evisceration.
ISSN:2050-313X
2050-313X
DOI:10.1177/2050313X231222211