Spontaneous transvaginal small bowel evisceration 40 years post-abdominal hysterectomy

A 77-year-old female patient known for chronic constipation presented to the emergency room with abdominal and perineal pain that appeared following straining in the toilet a few hours previously. No vomiting had occurred. On examination, it was found that ∼1 m of the small intestine, free of peritoneum, was protruding through the vagina (figure 1). The prolapsed intestinal loops were congested but appeared viable and contracted when touched. Examination of the anus was unremarkable. The patient was known to have had a total abdominal hysterectomy 40 years previously for uterine fibroids. She had also had a right hemicolectomy and a right inguinal …