A Case of Vaginal Rupture and Strangulated Bowel Obstruction Caused by Pessary Insertion

Abstract

We report herein on a case of ruptured vagina and strangulated bowel obstruction occurring during conservative therapy with a pessary for a vaginal stump prolapse. An 80-year old female patient had undergone a total hysterectomy for uterine fibroids approximately 40 years previously. One month prior to presenting, she was treated with a pessary for a vaginal stump prolapse but visited our hospital due to lack of improvement. Vaginal wall erosion and a 1-cm perforation were found. Although the decision to perform surgery was made shortly thereafter, on the same evening a small bowel prolapse from the vagina was observed, and the patient underwent an emergency laparotomy. Small bowel incompetence and a strangulated bowel obstruction due to the vaginal rupture were diagnosed, the small intestine was resected, and a colpocleisis was performed. Vaginal excision is performed more frequently in the elderly, and conservative treatment is often chosen, but in cases such as the present one, radical surgical intervention should be considered.