Vol. 43 (4): 766-769, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0249

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

 

ABSTRACT

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

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