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Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Paolo CROCE 1, Lucia PANZERI 1, Gabriele CROCE 2, Donatella PEROTTI 1, Silvia M. ZANCHI 1, Gianluca R. DAMIANI 1
1 Division of Gynecology, Lodi Hospital, Codogno, Italy; 2 Unit of Geriatrics, Cà Granda Institute for Scientific Research, Maggiore Polyclinic Hospital, Milan, Italy
This work reports two clinical cases of vaginal cuff dehiscence associated with evisceration of the bowel, considering a population of 290 patients. The first case is an 84-year-old patient, who had previously undergone two surgical operations for genital prolapse and showed the extrusion of small intestine through the vaginal introitus three years after the second surgery. The second case is a 75-year-old patient treated with radical hysterectomy six months before who successively developed a sigmoid-colon tract evisceration through vaginal cuff. In both cases a low profile polypropylene ePTFE mesh was placed to protect the suture and to keep the position of the pelvic floor. The first case had postsurgical paralytic ileus, was discharged in good conditions on the 14th postsurgical day. The second case had no complications during postsurgical period and was discharged in 10 days. Age, vaginal surgery and constipation could have played as favoring factors in the genesis of the vaginal dehiscence and following bowel evisceration in the first patient. This represents the only case of vaginal cuff dehiscence in our clinical records of 175 vaginal hysterectomies. Otherwise, neoplastic diagnosis, radical intervention, constipation and overweight might have caused the vaginal dehiscence in the second patient, who is the single one in our records of 115 laparohysterectomies. However, a careful assessment of initial symptoms might have prevented the bowel evisceration, which is surely the most serious event. The positioning of prosthetic pelvic mesh should protect the patient from any eventual recurrences.