PMC10372482_01
An image of the voluminous mass measuring approximately 15 cm protruding from the vagina showing areas of ulceration.
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F1
On physical examination, a painful voluminous mass protruded from the vaginal ostium, measuring approximately 15 cm, with a soft consistency, some bleeding ulcerations, and a highly dystrophic area showing initial signs of necrosis in the upper portion (Figure 1). Supplementary Figure S1 illustrates the case report timeline according to the CARE guidelines.
Ultrasonographic image of the vaginal prolapse showing the displaced omentum and bowel loops.
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F2
Upon placement of the probe over the vaginal prolapse site, displaced omentum and intestinal loops were visualized, with some having thicker walls (Figure 2).
Main steps of the surgical procedure. (A) Incision of the vaginal wall with a cold scalpel, (B) resection of the small intestine loop, (C) subsequent lateral anastomosis with breach sutures, and (D) postoperative outcome with a view of the reconstructed vagina.
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F3
After injection of an ischemic solution into the vaginal wall, a quantity of healthy tissue useful for reconstruction of the vaginal wall was identified and incised using a cold scalpel (Figure 3A). Therefore, the aforementioned loop was dissected using Ligasure  (Medtronic, Minneapolis, MN, USA) and an EndoGIA  mechanical stapler (Medtronic, Minneapolis, MN, USA), and a lateral anastomosis was subsequently created with breach sutures using a 3-0 V-lock  (Medtronic, Minneapolis, MN, USA) and 3-0 Vicryl (Ethicon, Raritan, NJ, USA) for the second layer (Figures 3B,C). We then removed excess vaginal tissue and reconstructed the vagina (Figure 3D) with introflecting stitches using non-absorbable multifilament sutures (Covidien, Mansfield, MA, USA).
Histological examination of the removed vagina and small bowel (hematoxylin and eosin 4x). (A) The vaginal wall with marked ectasia, lymphatic and vascular congestion in the stroma with severe edema, and exacerbated fibro-adherent serositis of the peritoneum lining the prolapsed vagina; (B) the vaginal wall lined with multilayered keratinizing squamous epithelium, marked ectasia, and lymphatic and vascular congestion in the stroma; and (C,D) small bowel sections showing ischemic-hemorrhagic necrosis of the small bowel mucosa and submucosal layer.
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F4
Small bowel sections showed transmural ischemic-hemorrhagic necrosis complicated with ulceration (Figure 4).