Cuff

A 60 year old postmenopausal woman with obesity, chronic smoker's cough, chronic constipation, diabetes, and psoriasis on infliximab undergoes a laparoscopic hysterectomy for uterine cancer. She appears to do well postoperatively; she tolerates a diet, ambulates, urinates, and has adequate pain control. Six months after her surgery, however, she presents with pelvic pain, vaginal bleeding, and vaginal pressure. Palpation on a bimanual exam feels like bowel is extruding from the vagina.

Challenge: What happened?

Image of a total laparoscopic hysterectomy shown under GNU Free Documentation License, from Wikipedia.