Emergency laparoscopic repair of coitus-induced vaginal cuff
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Vaginal cuff dehiscence is a rare but potentially grave complication after total hysterectomy. Abdominal or pelvic contents are at risk of evisceration through the vaginal opening. It is associated with significant risk for patient morbidity, such as peritonitis, bowel injury, and sepsis.

A 45-year-old woman had undergone abdominal total hysterectomy for adenomyosis and endometrioma at a local hospital 53 days prior to admission. She had an uncomplicated postoperative course. She presented with vaginal cuff dehiscence precipitated by sexual intercourse.

A standard four-port laparoscopy was performed with the umbilicus as the primary entry site using an 11 mm primary port and three 5 mm lateral accessory ports. On intraoperative examination, there were moderate adhesions between the left pelvic side wall and colon. There was a short loop of ileum protruding through the cuff which looked viable with no signs of ischemia or perforation

The cuff margins appeared inflamed. Careful downward dissection of her bladder and posterior peritoneum was carried out to achieve an adequate margin of vaginal cuff. Approximately 0.5 cm of cuff margin was excised circumferentially leaving viable tissue for proper suturing

A Jackson-Pratt drain was placed. Her postoperative course was uneventful. Intravenously administered antibiotics were completed and the drain was removed on the fifth postoperative day. She was followed up 2 weeks after discharge from our hospital: her pelvic examination revealed that the vaginal cuff was healing well. At a 1-month follow-up, her vaginal cuff was completely healed.

In conclusion, laparoscopic repair is a safe treatment option to manage vaginal cuff dehiscence after a total hysterectomy.

Source:https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-02362-4
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