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      Vaginal enterocele after cystectomy: A case report

      case-report

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          Abstract

          BACKGROUND

          After undergoing radical cystectomy combined with hysterectomy, female patients may suffer from pelvic organ prolapse due to the destruction of pelvic structures, which mainly manifests as the prolapse of tissues of the vulva to varying degrees and can be accompanied by symptoms, such as bleeding and inflammation. Once this complication is present, surgical intervention is needed to resolve it. Therefore, preventing and managing this complication is especially important.

          CASE SUMMARY

          The postoperative occurrence of acute enterocele is rare, and a case of acute small bowel vaginosis 2 mo after radical cystectomy with hysterectomy is reported. When the patient was admitted, physical examination revealed that the small bowel was displaced approximately 20 cm because of vaginocele. A team of gynecological, general surgery, and urological surgeons was employed to return the small bowel and repair the lacerated vaginal wall during the emergency operation. Eventually, the patient recovered, and no recurrence was seen in the half year of follow-up.

          CONCLUSION

          We review the surgical approach for such patients, analyze high-risk factors for the disease and suggest corresponding preventive measures.

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          Most cited references17

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          The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.

          This article presents a standard system of terminology recently approved by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse and pelvic floor dysfunction. An objective site-specific system for describing, quantitating, and staging pelvic support in women is included. It has been developed to enhance both clinical and academic communication regarding individual patients and populations of patients. Clinicians and researchers caring for women with pelvic organ prolapse and pelvic floor dysfunction are encouraged to learn and use the system.
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            Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence

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              Implementation of a surgical comprehensive unit-based safety program to reduce surgical site infections.

              Surgical site infections (SSI) are a common and costly problem, prolonging hospitalization and increasing readmission. Adherence to well-known infection control process measures has not been associated with substantial reductions in SSI. To date, the global burden of preventable SSI continues to result in patient harm and increased health care costs on a broad scale. We designed a study to evaluate the association between implementation of a surgery-based comprehensive unit-based safety program (CUSP) and postoperative SSI rates. One year of pre- and post-CUSP intervention SSI rates were collected using the high-risk pilot module of the American College of Surgeons National Surgical Quality Improvement Program (July 2009 to July 2011). The CUSP group met monthly and consisted of a multidisciplinary team of front-line providers (eg, surgeons, nurses, operating room technicians, and anesthesiologists) who were directly involved in the care of colorectal surgery patients. Surgical Care Improvement Project process measure compliance was monitored using standard methods from the Centers for Medicare and Medicaid Services. In the 12 months before implementation of the CUSP and interventions, the mean SSI rate was 27.3% (76 of 278 patients). After commencement of interventions, the rate was 18.2% (59 of 324 patients) for the subsequent 12 months--a 33.3% decrease (95% CI, 9-58%; p < 0.05). The interventions included standardization of skin preparation; administration of preoperative chlorhexidine showers; selective elimination of mechanical bowel preparation; warming of patients in the preanesthesia area; adoption of enhanced sterile techniques for skin and fascial closure; addressing previously unrecognized lapses in antibiotic prophylaxis. There was no difference in surgical process measure compliance as measured by the Surgical Care Improvement Project during the same time period. Formation of small groups of front-line providers to address patient harm using local wisdom and existing evidence can improve patient safety. We demonstrate a surgery-based CUSP intervention that might have markedly decreased SSI in a high-risk population. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Journal
                World J Clin Cases
                WJCC
                World Journal of Clinical Cases
                Baishideng Publishing Group Inc
                2307-8960
                26 February 2022
                26 February 2022
                : 10
                : 6
                : 2045-2052
                Affiliations
                Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Clinical Medicine, Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Clinical Medicine, Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Clinical Medicine, Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Clinical Medicine, Qingdao University, Qingdao 266000, Shandong Province, China
                Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China. jiaowei3929@ 123456163.com
                Author notes

                Author contributions: Liu SH, Niu HT, Jiao W were the patient's urologists, reviewed the literature analyzed the data and contributed to manuscript drafting; Zhang YH reviewed the literature; Qin F and Tian DX contributed to manuscript drafting; Jiao W analyzed and interpreted the imaging findings; all authors issued final approval for the version to be submitted.

                Corresponding author: Wei Jiao, MD, Academic Research, Adjunct Professor, Department of Urology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266000, Shandong Province, China. jiaowei3929@ 123456163.com

                Article
                jWJCC.v10.i6.pg2045
                10.12998/wjcc.v10.i6.2045
                8891769
                35317139
                4081c236-0c43-4edc-8991-22ffa932e411
                ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

                History
                : 8 October 2021
                : 9 November 2021
                : 14 January 2022
                Categories
                Case Report

                acute enterocele,complication,pelvic organ prolapse,prevention,repair,case report

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