title: Subtle vaginal evisceration resulting in small bowel evisceration: a case report.
abstract: BACKGROUND
  Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction.
  
  
  OBJECTIVE
  We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence.
  
  
  METHODS
  A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room.
  
  
  CONCLUSIONS
  Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.
authors: Department of Emergency Medicine, Beth Israel Medical Center, New York, New York 10003, USA.
authors: Kar-mun C
authors: KM
authors: Woo
authors: Judith A
authors: JA
authors: Linden
authors: Robert A
authors: RA
authors: Lowenstein
authors: Jose C
authors: JC
authors: Varghese
authors: Miguel A
authors: MA
authors: Burch
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small; D020047:Rectocele / Q000150:complications; D012307:Risk Factors; D014596:Uterine Prolapse / Q000150:complications* / Q000601:surgery; D014782:Visceral Prolapse / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery