Vaginal Cuff Dehiscence and Evisceration After Total Hysterectomy

Incidence of vaginal cuff dehiscence after hysterectomy ranges from 0.14-4.1%.

Risk factors include post-operative infection, radiotherapy, chemotherapy, early return to sexual intercourse, constipation

Surgical emergency with risk of bowel necrosis.

Use gauze soaked in warm saline to reduce bowel and then pack vaginal vault prior to transport to OR.  Alternatively, cover exposed bowel with soaked gauze. Immediate consultation with general surgery and gynecology is necessary.  Provide antibiotics and update tetanus status.

References

Nezhat, C et al. (2018). Vaginal cuff dehiscence and evisceration: A review. Obstetrics and Gynecology 132(4), 972-985.