Chronic Bowel Evisceration Contained within the Vagina by Fibrosed Peritoneum

Objectives: The objectives of this video are to review the presentation, evaluation, and surgical management of a patient with chronic bowel evisceration contained within the vagina by a fibrotic membrane that completely occluded the vaginal introitus.

Methods: We present the case of a 65-year-old G4P3013 patient with a history of total abdominal hysterectomy more than twenty years ago for abnormal uterine bleeding. She did not have gynecologic exams for the 20 years following her surgery. On exam, the vaginal introitus was noted to be completely occluded by a fibrotic membrane with some leukoplakia. Punch biopsy was performed in the clinic and epiploica prolapsed from the biopsy site, raising suspicion for chronic vaginal cuff dehiscence. A CT scan confirmed that bowel was prolapsed into the vagina. Exam under anesthesia and surgical management were recommended. The patient underwent vaginal septum excision, reduction of the prolapsed bowel, uterosacral ligament suspension, and vaginal cuff closure. Final pathology of the vaginal septum showed squamous mucosa with fibroinflammatory changes.

Clinical Relevance: This is a rare case of chronic vaginal cuff dehiscence with bowel evisceration that was contained within the vagina due to complete occlusion of the vaginal introitus by a fibrotic membrane. The vaginal anatomy was able to be partially restored through excision of the septum and apical support with uterosacral sutures.