A Rare Case of Spontaneous Transvaginal Intestinal Evisceration

To the Editor Transvaginal intestinal evisceration is a rare surgical emergency, complicated by bowel ischemia, ileus and peritonitis.It was first reported in 1864 by Hyernaux [1] and then by McGregor in 1907 [2].It is very rare and fewer than 150 cases have been described worldwide [3,4].It can occur more often in elderly postmenopausal women than in younger women [5,6].Bowel evisceration is a complication of gynecologic surgery, typically arising in conjunction with trauma or conditions heightening intra-abdominal pressure.The clinical presentation is that of intestinal obstruction due to bowel herniation through the vagina.A 55-year-old woman presented to the Department of Accident and Emergency for abdominal pain and transvaginal intestinal evisceration.She reported a previous diagnosis of ovarian cancer five years before, treated with laparoscopic bilateral hystero -oophorectomy and chemotherapy.Histological diagnosis was Epithelial Ovarian Carcinoma.During hospitalization, laboratory exams were conducted with the following results: leukocytosis (13.0 × 10 3 /μL), increased C-reactive protein (CRP) (300 mg/L), and hyperlactatemia (lactate 4.1 mmol/L).Computed tomography (CT) scan (Fig. 1A,B) showed reduced blood flow in the eviscerated intestinal loop.The eviscerated intestine, appearing edematous, thickened, and discolored (Fig. 2A), was wrapped with warm sterile saline-soaked gauze.The patient received intravenous broad-spectrum antibiotics, including cefazolin and metronidazole, together with intravenous fluid therapy, and was taken to the operating room.After induction of general anesthesia, manual reduction of the eviscerated bowel was performed through the vagina, and vaginal packing with gauze was placed to prevent recurrent intestinal prolapse.Surgical intervention started with a midline incision.Abdominal exploration revealed purulent contamination of the abdominal cavity and a laceration