Vaginal vault evisceration after total laparoscopic hysterectomy.
BACKGROUND
Vaginal vault rupture with intestinal herniation, although rare, is a recognized postoperative complication of vaginal and abdominal hysterectomies. The incidence after laparoscopic hysterectomy is unknown.


METHODS
Three women, ages 40-43 years, presented to the emergency room with bleeding and pain 2-5 months after total laparoscopic hysterectomy. The small bowel was visible through the introitus or protruding into the vagina. Inspection of the bowel revealed no evidence of trauma. Two vaginal cuff repairs were completed transvaginally and one laparoscopically, all with interrupted sutures of no. 0 polydioxanone or polyglactin. In follow-up period of 12-17 months, the patients were doing well.


CONCLUSIONS
Total laparoscopic hysterectomy may be associated with an increased risk of vaginal vault evisceration. Because laparoscopy increasingly is used to replace abdominal hysterectomy, it is important to be aware of this complication and its management.
Nezhat
C H
CH
Department of Gynecology and Obstetrics, Stanford University School of Medicine, California, USA.
Nezhat
F
F
Seidman
D S
DS
Nezhat
C
C
D000328:Adult; D003075:Coitus; D005260:Female; D006547:Hernia / Q000209:etiology; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007410:Intestinal Diseases / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D011391:Prolapse; D012422:Rupture, Spontaneous; D014623:Vaginal Diseases / Q000209:etiology*