Introduction: In the past, management of bowel pathology occurring within post radical cystectomy vaginal prolapse has been described via an abdominal surgical approach. This case demonstrates concomitant advanced pelvic organ prolapse and partial small bowel obstruction managed via transvaginal small bowel resection and colpocleisis.
Methods: The patient is an 82-year-old female with a history of a radical cystectomy and ileal conduit two years prior for bladder cancer, that was transferred from an outside hospital for incarcerated vaginal prolapse including a small bowel obstruction with transition point inside the prolapse. She had previously unsuccessfully tried several pessaries for her prolapse. She was widowed and not sexually active. After conservative management of her bowel obstruction was unsuccessful, she was taken to the operating room for transvaginal exploration and prolapse repair, with the understanding than an abdominal approach may be needed. Intraoperatively, with transvaginal intraperitoneal access we identified an isolated area of indurated small bowel adherent to the prolapse. Colorectal Surgery performed a transvaginal small bowel resection with stapled anastomosis and a modified colpocleisis was performed to address her prolapse.
Results: Her postoperative course was uncomplicated and at 6 months, she reported normal bowel function and had no evidence of prolapse recurrence.
Conclusions: We present a case of bowel pathology associated with vaginal prolapse, managed with transvaginal small bowel resection and colpocleisis. This case demonstrates the feasibility of this procedure when working with a multi-disciplinary team and localized bowel pathology.