Vol. 43 (4): 766-769, July – August, 2017
CHALLENGING CLINICAL CASES
Lucas Schreiner 1, Thais Guimarães dos Santos 1, Christiana Campani Nygaard 2, Daniele Sparemberger Oliveira 2
1 Departamento de Obstetrícia e Ginecologia do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brasil; 2 Serviço de Uroginecologia do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brasil
Background: Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation.
Case Report: A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation.
Case hypothesis: This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.
Keywords: Prolapse; Vagina; Lupus Erythematosus, Systemic