Вагинальная эвентрация кишечника после лапароскопической гистерэктомии

Лысяк Денис Сергеевич; Арутюнян Елена Владимировна; Конеева Елена Яковлевна; Соловьев Виталий Викторович; Денисова Ксения Александровна

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Журнал

Амурский медицинский журнал

2024

Область наук

Клиническая медицина

Ключевые слова

гистерэктомия / эвентрация кишечника / лапароскопия / hysterectomy / intestinal eventration / laparoscopy

Аннотация научной статьи по клинической медицине, автор научной работы — Лысяк Денис Сергеевич, Арутюнян Елена Владимировна, Конеева Елена Яковлевна, Соловьев Виталий Викторович, Денисова Ксения Александровна

Эвентрация кишечника через дефект в стенке культи влагалища после гистерэктомии крайне редкое осложнение и требует оказания экстренной хирургической помощи. Ущемленная петля кишки с некрозом может стать причиной развития перитонита, сепсиса и летального исхода. В последние годы сообщается об увеличении числа такого осложнения после выполненной операции роботизированным методом и лапароскопическим доступом по сравнению с влагалищным и лапаротомным. Цель нашего наблюдения представить редкий случай отдаленного осложнения лапароскопической гистерэктомии у пациентки с раком эндометрия, указать на возможные факторы риска и метод коррекции. У пациентки без явных факторов риска через три месяца после удаления матки произошла эвентрация петли тонкого кишечника через влагалище, триггером которой послужил половой акт. В результате раннего обращения признаков некроза кишки и перитонита не было, что дало возможность для вправления и устранения дефекта вагинальным доступом.

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Vaginal bowel eventration after laparoscopic hysterectomy

Eventration of the intestine through a defect in the wall of the vaginal stump after hysterectomy is an extremely rare complication and requires emergency surgical care. A strangulated loop of intestine with necrosis can cause the development of peritonitis, sepsis and death. In recent years, an increase in the number of such complications has been reported after surgery performed using the robotic method and laparoscopic approach compared to vaginal and laparotomy. The purpose of our observation is to present a rare case of long-term complication of laparoscopic hysterectomy in a patient with endometrial cancer, to indicate possible risk factors and a method of correction. In a young non-smoking patient without obvious risk factors, three months after removal of the uterus, an eventration of a loop of the small intestine through the vagina occurred, the trigger of which was sexual intercourse. As a result of early treatment, there were no signs of intestinal necrosis and peritonitis, which made it possible to reduce and eliminate the defect through vaginal access.

Текст научной работы на тему «Вагинальная эвентрация кишечника после лапароскопической гистерэктомии»

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Original article

VAGINAL BOWEL EVENTRATION AFTER LAPAROSCOPIC HYSTERECTOMY

Denis S. Lysyak1, Elena V. Arutyunyan2, Elena Y. Koneeva1,2, Vitaly V. Solovyov2, Ksenia A. Denisova2

1 Amur State Medical Academy of the Ministry of Health of the Russian Federation, Blagoveshchensk,

Russia; [email protected] 2 Amur Regional Clinical Hospital, Blagoveshchensk, Russia

Abstract. Eventration of the intestine through a defect in the wall of the vaginal stump after hysterectomy is an extremely rare complication and requires emergency surgical care. A strangulated loop of intestine with necrosis can cause the development of peritonitis, sepsis and death. In recent years, an increase in the number of such complications has been reported after surgery performed using the robotic method and laparoscopic approach compared to vaginal and laparotomy. The purpose of our observation is to present a rare case of long-term complication of laparoscopic hysterectomy in a patient with endometrial cancer, to indicate possible risk factors and a method of correction. In a young non-smoking patient without obvious risk factors, three months after removal of the uterus, an eventration of a loop of the small intestine through the vagina occurred, the trigger of which was sexual intercourse. As a result of early treatment, there were no signs of intestinal necrosis and peritonitis, which made it possible to reduce and eliminate the defect through vaginal access.

Keywords: hysterectomy, intestinal eventration, laparoscopy.

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For citation: Lysyak DS, Arutyunyan EV, Koneeva EV, Solovyov VV, Denisova KA. Vaginal�naya eventratsiya kishechnika posle laparoskopicheskoi gisterektomii [Vaginal bowel eventration after laparoscopic hysterectomy]. Amurskii meditsinskii zhurnal. � Amur Medical Journal. 2024;12;1(36):52�56. (In Russ.). https://doi.org/10.24412/2311-5068-2023-11-2-52.

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2.

Chan A. K. Y., Oluwajobi O., Ehsan A., Tahmasebi F. Transvaginal Evisceration of the Small Bowel More Than 15 Years After Abdominal Hysterectomy and Vaginal Surgery // Cureus. 2021. Vol. 13(3). e13955. https://doi.org/10.7759/cureus.13955.

3.

Daza Manzano C., Martinez Maestre M. A., Gonzalez Cejudo C. et al. Small bowel and omentum evisceration after abdominal hysterectomy // Gynecol Surg. 2005. Vol. 2. P. 33�34. https://doi.org/10.1007/ s10397-004-0080-6.

4.

Hur H. C., Guido R. S., Mansuria S. M., Hacker M. R., Sanfilippo J. S., Lee T. T. Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies // J Minim Invasive Gynecol. 2007. Vol. 14(3). P. 311�317. https://doi.org/10.1016/j.jmig.2006.11.005.

5.

Kho R. M., Akl M. N., Cornella J. L., Magtibay P. M., Wechter M. E., Magrina J. F. Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures // Obstet Gynecol. 2009. Vol. 114(2 Pt 1). P. 231�235. https://doi.org/10.1097/AOG.0b013e3181af36e3.

6.

Lee D. H., Kim E. T., Jo H. B., Hwang S. Y., Lee N. K., Suh D. S., Kim K. H. Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer: A case report // Medicine (Baltimore). 2022. Vol. 101(17). e29225. https://doi.org/10.1097/MD.0000000000029225.

7.

Matsuhashi T., Nakanishi K., Hamano E., Kamoi S., Takeshita T. Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review // J Nippon Med Sch. 2017. Vol. 84(2). P. 90�95. https://doi.org/10.1272/jnms.84.90. PMID: 28502966.

8.

Nikolopoulos I., Khan H., Janakan G., Kerwat R. Laparoscopically assisted repair of vaginal evisceration after hysterectomy // BMJ Case Rep. 2013. bcr2013009897. https://doi.org/10.1136/bcr-2013-009897.

9.

Rueda Espinel S., Cobos Mantilla F. Management of transvaginal bowel evisceration secondary to vaginal cuff dehiscence following hysterectomy: Case report and review of the literature // Rev. colomb. obstet. ginecol. 2019. Vol. 70(2). P. 129�135.

10.Tsakona S., Iavazzo C., Fotiou A., Kokkali K., Vorgias G.. Vaginal Evisceration After Abdominal Hysterectomy: A Case Report // Cureus. 2022. Vol. 14(11). e31191. https://doi.org/10.7759/cureus.31191.

11.Uccella S., Malzoni M., Cromi A., Seracchioli R., Ciravolo G., Fanfani F., Shakir F., Gueli Alletti S., Legge F., Berretta R., Corrado G., Casarella L., Donarini P., Zanello M., Perrone E., Gisone B., Vizza E., Scambia G., Ghezzi F. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy // Am J Obstet Gynecol. 2018. Vol. 218(5). 500.e1-500.e13. https://doi.org/10.1016/j.ajog.2018.01.029.

References

1.

Kurdo SA, Komarov RN, Lakunin KYu, Kim PP. Evisceration of the intestines through the vaginal stump after laparoscopic hysterectomy. Pirogov Russian Journal of Surgery. 2012;12:65�66. (In Russ.).

2.

Chan AKY, Oluwajobi O, Ehsan A, Tahmasebi F. Transvaginal Evisceration of the Small Bowel More Than 15 Years After Abdominal Hysterectomy and Vaginal Surgery. Cureus. 2021;13(3):e13955. https://doi. org/10.7759/cureus.13955.

3.

Daza Manzano C, Martinez Maestre MA, Gonzalez Cejudo C., et al. Small bowel and omentum evisceration after abdominal hysterectomy. Gynecol Surg. 2005;2:33�34. https://doi.org/10.1007/s10397�004-0080-6.

4.

Hur HC, Guido RS, Mansuria SM, Hacker MR, Sanfilippo JS, Lee TT. Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies. J Minim Invasive Gynecol. 2007;14(3):311�317. https://doi.org/10.1016/j.jmig.2006.11.005.

5.

Kho RM, Akl MN, Cornella JL, Magtibay PM, Wechter ME, Magrina JF. Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures // Obstet Gynecol. � 2009. � Vol. 114(2 Pt 1). � P. 231-235. DOI: 10.1097/AOG.0b013e3181af36e3.

6.

Lee DH, Kim ET, Jo HB, Hwang SY, Lee NK, Suh DS, et al. Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer: A case report. Medicine (Baltimore). 2022;101(17):e29225. https://doi.org/10.1097/MD.0000000000029225.

7.

Matsuhashi T., Nakanishi K., Hamano E., Kamoi S., Takeshita T. Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review. J Nippon Med Sch. 2017;84(2):90�95. https://doi.org/10.1272/jnms.84.90. PMID: 28502966.

8.

Nikolopoulos I, Khan H, Janakan G, Kerwat R. Laparoscopically assisted repair of vaginal evisceration after hysterectomy. BMJ Case Rep. 2013:bcr2013009897. https://doi.org/10.1136/bcr-2013-009897.

9.

Rueda Espinel S, Cobos Mantilla F. Management of transvaginal bowel evisceration secondary to vaginal cuff dehiscence following hysterectomy: Case report and review of the literature. Rev. colomb. obstet. ginecol. 2019;70(2):129�135.

10.Tsakona S., Iavazzo C., Fotiou A., Kokkali K., Vorgias G.. Vaginal Evisceration After Abdominal Hysterectomy: A Case Report. Cureus. 2022;14(11):e31191. https://doi.org/10.7759/cureus.31191.

11.Uccella S, Malzoni M, Cromi A, Seracchioli R, Ciravolo G, Fanfani F, et al. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol. 2018;218(5):500.e1�500.e13. https://doi.org/10.1016/j.ajog.2018.01.029.

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Вагинальная эвентрация кишечника после лапароскопической гистерэктомии Текст научной статьи по специальности «Клиническая медицина»

Vaginal bowel eventration after laparoscopic hysterectomy

Текст научной работы на тему «Вагинальная эвентрация кишечника после лапароскопической гистерэктомии»