Document Type : Case reports


1 Assistant Professor of Surgery, Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

4 4 Assistant Professor of General Surgery, Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran

5 General Surgery Resident, Department of General Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: The etiology of pelvic organ prolapse is multifactorial. Age and parity are especially the two most important risk factors for this condition. Small bowel obstruction is one of the most common clinical presentations to the emergency department that can result in significant morbidity and mortality.
Case presentation: A 79-year-old woman with a previous history of uterine prolapse and no previous history of intraabdominal surgery or malignancies presented with nausea and vomiting, abdominal pain, and constipation from 2 days ago. Upright and supine x-rays showed dilated small bowel loops and confirmed bowel obstruction. Due to primary obstruction, the patient was a candidate for surgery. During the surgery, we observed that 100 cm of the terminal ileum and the uterus protruded in the vaginal canal and the ileal loops were strangulated. We decided to perform a right hemicolectomy surgery.
Conclusion: In patients with uterine prolapse, we suggest a careful examination and consideration of the entrapment of small bowel loops in the prolapse site as a rare cause of small bowel obstruction.


  1. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;35(2):137-68. doi: 10.1007/s00192-015-2932-1. [PubMed: 26755051].
  2. Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795-806. doi: 10.1016/j.ajog.2004.10.602. [PubMed: 15746674].
  3. Tinelli A, Malvasi A, Rahimi S, Negro R, Vergara D, Martignago R, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause. 2010;17(1):204-12. doi: 10.1097/gme.0b013e3181b0c2ae. [PubMed: 19629013].
  4. Welch J. General consideration and mortality in bowel obstruction. Bowel obstruction: differential diagnosis and clinical management. Philadelphia, Pa: Saunders; 1990.
  5. Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203(2):170-6. doi: 10.1016/j.jamcollsurg.2006.04.020. [PubMed: 16864029].
  6. Hayanga AJ, Bass-Wilkins K, Bulkley GB. Current management of small-bowel obstruction. Adv Surg. 2005;39:1-33. doi: 10.1016/j.yasu.2005.05.001. [PubMed: 16250544].
  7. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703-17. doi: 10.2214/AJR.05.0644. [PubMed: 16498098].
  8. Tayade H, Tayade S, Yeola M, Lamture Y. Gangrenous small bowel due to reposition of procidentia in an elderly woman. Cureus. 2022;14(5):e25013. doi: 10.7759/cureus.25013. [PubMed: 35712331].
  9. Carley ME, Gonzalez Bosquet J, Stanhope CR. Small bowel obstruction associated with post-hysterectomy vaginal
  10. vault prolapse. Obstet Gynecol. 2003;102(3):524-6. doi: 10.1016/s0029-7844(03)00160-1. [PubMed: 12962936].
  11. Barnfield S, Kassab A, Fox R. Reversible small bowel obstruction secondary to vaginal vault prolapse. J Obstet Gynaecol. 2007;27(6):633-4. doi: 10.1080/01443610701554775.
  12. Wilkinson KH, Thomas A, Theobald J. Pelvic organ prolapse: An unusual cause of small bowel obstruction. Am J Emerg Med. 2019;37(9):1809. doi: 10.1016/j.ajem.2019.06.037. [PubMed: 31255427].
  13. Halwani Y, Nicolau-Toulouse V, Oakes J, Leipsic J, Geoffrion R, Wiseman SM. Transvaginal strangulated small intestinal hernia after abdominal sacrocolpopexy: case report and literature review. Hernia. 2013;17(2):279-83. doi: 10.1007/s10029-011-0848-3. [PubMed: 21761210].
  14. Verity L, Bombieri L. Vaginal evisceration, small bowel prolapse and acute obstruction as a late complication of sacrospinous fixation. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(1):77-8. doi: 10.1007/s00192-004-1214-0. [PubMed: 15316594].
  15. Farrell S, Scotti R, Ostergard D, Bent A. Massive evisceration: a complication following sacrospinous vaginal vault fixation. Obstet Gynecol. 1991;78(3):560-2. [PubMed: 1870824].
  16. Kisby CK, Kelley SR, Linder BJ. Management of advanced prolapse including a bowel obstruction: expanding the role of transvaginal surgery. Int Urogynecol J. 2022;33(1):153-5. doi: 10.1007/s00192-021-05027-y. [PubMed: 34851440].
  17. Woo KM, Linden JA, Lowenstein RA, Varghese JC, Burch MA. Subtle vaginal evisceration resulting in small bowel evisceration: a case report. J Emerg Med. 2012;43(2):125-8. doi: 10.1016/j.jemermed.2011.06.003. [PubMed: 21903354].