Transvaginal bowel evisceration and gangrenous small-bowel obstruction after self-amputation of neglected uterovaginal prolapse: a case report and review of literature

Neglected uterovaginal prolapse (UVP) can lead to life-threatening complications. We report a 45-year-old para 5 woman with a 10-year history of UVP who presented after 2 days of a protruding vaginal mass, bilious vomiting, fever, and abdominal pain following an attempt to cut the prolapsed tissue with a blade. On examination, she was tachycardic, hypotensive, actively bleeding from the prolapse, and showed signs of small-bowel evisceration. Emergency laparotomy identified a 4-cm anterior uterine defect with 60 cm gangrenous ileum herniated ~15 cm from the ileocecal junction; the necrotic segment was resected and an ileostomy created, and definitive repair of the prolapse was performed. The patient recovered and was discharged on postoperative day seven. This case shows that neglected UVP may prompt desperate, dangerous self-interventions and can cause transvaginal bowel evisceration and strangulation; early recognition, prompt multidisciplinary surgical care, and attention to psychosocial barriers to care are essential to prevent such outcomes.