Transvaginal evisceration progressing to peritonitis in the emergency department: a case report
1 Department of Emergency Medicine, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834 USA
2 Johnston Memorial Hospital, 351 Court Street North East, Abingdon, VA 24210 USA
International Journal of Emergency Medicine 2011, 4:66 doi:10.1186/1865-1380-4-66Published: 13 October 2011
Abdominal pain is a common complaint among emergency department patients, making it essential to identify those with life-threatening etiologies. We report on the rare finding of atraumatic transvaginal bowel evisceration in a patient presenting to the emergency department with the primary complaint of abdominal pain.
A 63-year-old female presented ambulatory to the emergency department with abdominal pain and foreign body sensation in her vagina after coughing. Physical exam demonstrated evisceration of her small bowel through her vagina. During her clinical course, she rapidly deteriorated from appearing well without abdominal tenderness to hypotensive with frank peritonitis.
This case demonstrates the need to perform a thorough physical exam on all patients with abdominal pain and details the management of vaginal evisceration. This case also highlights the difficulty of appropriate triage for patients with complaints not easily assessed in triage. In an era of emergency department crowding, emergency physicians should reevaluate nursing education on triaging abdominal pain to prevent delays in caring for well-appearing patients who have underlying life-threatening illnesses.