In emergency surgical admissions, acute bowel obstruction is a very common problem. The causes of bowel obstruction are numerous but the most frequently identified are adhesions and post-operative bands, hernias, tumours and congenital bands. Evisceration of the small intestine through the vagina is a rare surgical emergency that requires urgent surgery because of the risk of developing acute small bowel obstruction and ischemia. We report a very rare and unusual case of an acute abdomen with bowel obstruction in a 70-year-old non-hysterectomized woman, with the majority of the small bowel visible outside the vagina, which has become strangulated and gangrenous. An exploratory laparotomy was performed urgently with resection and anastomosis of the small bowel and closure of the breach in the Douglas pouch. Multiple approaches to surgical management have been described, including laparoscopy, laparotomy, transvaginal route, and combined approaches. Perineal hernia should be considered in the differential diagnosis in elderly post-hysterectomy patients with sudden onset of abdominal pain where urgent surgical intervention is advised.
Bendjaballah A*, Taieb M, Haidar A, Khiali R, Ammari S, Khetra Z and Nait Slimane M