# A Rare Case of Transvaginal Sigmoid Evisceration in a Patient with Recurrent Pelvic Organ Prolapse

## TL;DR

A 67-year-old woman with a history of pelvic surgeries experienced a rare case of bowel evisceration, requiring urgent surgical intervention.

## Contribution

This case highlights the importance of considering bowel evisceration in patients with a history of pelvic organ prolapse and subacute worsening symptoms.

## Key findings

- Bowel evisceration was diagnosed in a patient with a history of multiple pelvic surgeries.
- The patient required surgical resection and colostomy due to the complication.
- Risk factors like prior pelvic surgery and postmenopausal status were present.

## Abstract

Large bowel evisceration is a rare but morbid presentation that requires timely diagnosis and management. We present the case of a 67-year-old woman with a history of recurrent pelvic organ prolapse (notably with a history of prior hysterectomy, mesh-augmented sacrocolpopexy, and transvaginal Uphold™ mesh placement). She presented with the subjective report of subacute worsening of her prolapse leading to urinary retention managed with a Foley catheter and an irreducible vaginal mass prompting evaluation. Clinical evaluation revealed bowel contents in the vagina with subsequent initiation of intravenous antibiotics, diagnostic laparoscopy converted to exploratory laparotomy, and resection of sigmoid and upper rectum with creation of left ileal end colostomy. Common risk factors for bowel evisceration include older age, postmenopausal status, history of pelvic surgery, and pessary use. In a patient with subacute worsening of prolapse and pain with the above risk factors, bowel evisceration should be considered and ruled out.