She coughs … and sees her intestine getting out of her body: what this extreme case reveals according to Dr. Kierzek

She coughs ... and sees her intestine getting out of her body: what this extreme case reveals according to Dr. Kierzek
It seems incredible, but it is medically possible: after a coughing fifth, a 61 -year -old woman saw her intestine spring from her vagina. Dr. Gérald Kierzek deciphers this extremely rare but serious complication, often linked to an old gynecological surgery.

This type of complication is as impressive as they are unknown. A 61 -year -old woman saw her small intestine argued – that is to say getting out of her body – after a fifth of violent cough. His case was the subject of a publication in the journal Taiwanese Journal of Obstetrics and Gynecology.

A rare complication, following a uterus operation

This impressive situation occurred on a Taiwanese sixties after removing the uterus. This hysterectomy was weakened by cough efforts, made by the patient.

In addition to a post-operative malformation, she found herself with her organs which left her body vaginal.

Cough, hysterectomy and intestine, an unexpected but real link

The patient went to the emergency room for strong abdominal pain. She had undergone this hysterectomy ten months earlier without complications. During the exam, the doctors found that part of his intestine exceeded his vagina.

Emergency surgery has made it possible to close a defect in its vaginal wall, thus avoiding serious complications.

The patient was diagnosed with dehiscence of the vaginal cap. In other words, a reopening of the post-hysterectomy internal scar, with evisceration of the small intestine.

A known phenomenon, but which only occurs in 0.032 % of cases after pelvic surgery. The risk climbs with age: up to 10 % of patients after certain abdominal operations can experience the wound opening.

In this case, it is a vital surgical emergency. Indeed, the organs exposed risk infection, then necrosis and the patient, massive blood loss.

What the pelvic prolapse reveals according to Dr Gérald Kierzek

“”Pelvic prolapse (organ descent) can occur after a hysterectomy because the ablation of the uterus weakens the architecture of the pelvic floor “ explains Dr. Gérald Kierzek, emergency doctor and medical director of True Medical.

“Normally, the uterus serves as a support point for other organs, such as vagina, bladder or rectum. Its withdrawal creates an anatomical vacuum, and ligaments weakened by age, childbirth or repeated efforts (constipation, carrying of loads) can let the adjacent organs slide down”.

The most common prolapse concerns the descent of the bladder (cystocele) or the rectum (rectocele) in the vagina. They cause urinary, digestive disorders or pelvic discomfort.

When the scar tissues are fragile and efforts like coughs exert sudden pressure on the area, the consequences can be serious. “This is an anatomical imbalance favored by time, but also by repeated internal pressures“Summarizes Dr. Kierzek.

Prevent complications after hysterectomy: good reflexes

These extreme cases recall that the consequences of a hysterectomy must be subject to attentive gynecological management, even several months after the operation. In the event of chronic cough or respiratory disease, it is important to inform your attending physician, especially in the event of known prolapse.

To reduce the risks, Dr. Kierzek recommends perineal rehabilitation. “”Kegel exercises strengthen the muscles of the pelvic floor, while an adapted lifestyle (avoid constipation, impact sports) limits abdominal pressures “.

In the event of confirmed prolapse, support devices (pessary) or reconstructive surgery can be considered.

But above all, regular monitoring makes it possible to detect anatomical weaknesses before a banal act – like a cough – triggers a dramatic incident. “”It is not inevitable, but an alert signal not to ignore“Concludes the emergency doctor.