Delayed presentation of vaginal cuff dehiscence and evisceration of bowel after laparoscopic hysterectomy and adjuvant radiation therapy

Introduction: Total hysterectomy (TH) is one of the most commonly performed gynecologic procedures, with complications including genitourinary or gastrointestinal injury, bleeding, infection, and rarely vaginal cuff dehiscence (VCD). Vaginal cuff dehiscence is an uncommon but potentially life-threatening complication, particularly associated with laparoscopic hysterectomy and may present with bowel evisceration requiring urgent intervention. Case Report: We present the case of a woman in her 50s with a history of radical hysterectomy and adjuvant radiation for cervical cancer, who presented with acute abdominal pain and small bowel evisceration through the vagina. Emergent laparotomy was performed with small bowel resection and anastomosis, followed by transvaginal repair of the vaginal cuff. Conclusion: This case highlights the importance of early recognition and individualized management based on patient status and intraoperative findings, with careful assessment of bowel viability prior to cuff closure. In addition to surgical outcomes, psychological consequences following such events can be significant, emphasizing the need for early counseling.