An endometriotic vault fistula presenting with monthly bleeding after hysterectomy

Introduction The aetiology of endometriosis remains unknown. The clinical presentation of endometriosis can be highly variable, occurring in numerous potential locations outside the abdomen and associated with distinct complaints. Recurrence is common, though we present a very rare case of recurrenc...

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Bibliographic Details
Published in:Archives of gynecology and obstetrics 2009-12, Vol.280 (6), p.1011-1014
Main Authors: Aydin, Yavuz, Atis, Alev, Ercan, Erdal, Donmez, Melahat
Format: Article
Language:English
Subjects:
Adult
Case Report
Endocrinology
Endometriosis
Endometriosis - diagnosis
Endometriosis - pathology
Endometriosis - surgery
Female
Fistula
Gynecology
Histocytochemistry
Human Genetics
Humans
Hysterectomy
Medicine
Medicine & Public Health
Obstetrics/Perinatology/Midwifery
Ovariectomy
Vaginal Fistula - diagnosis
Vaginal Fistula - pathology
Vaginal Fistula - surgery
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Summary:Introduction The aetiology of endometriosis remains unknown. The clinical presentation of endometriosis can be highly variable, occurring in numerous potential locations outside the abdomen and associated with distinct complaints. Recurrence is common, though we present a very rare case of recurrence and complication. Case presentation A 42-year-old caucasian woman was admitted to our unite with monthly vaginal bleeding lasting 3–5 days, beginning from 6 months after previous hysterectomy and right salpingo-oophorectomy surgery for myoma and endometrioma. We suspected of endometrioma of the left ovarium upon transvaginal ultrasonography, and diagnosed vault fistula from the endometriosis cyst to the vagina. We re-operated the patient using Pfannenstiel incision, and performed left-oophorectomy and fistula repairment. The Pouch of Douglas was obliterated and many bowel adhesions were present, indicating a stage IV endometriosis. According to our assessment, stage IV endometriosis had been present in the previous surgery. Conclusions Considering that the short-term endometriosis recurrence is higher in premenopausal age and in advanced stage of endometriosis, bilateral oophorectomy together with hysterectomy may be a better operational choice for these patients.
ISSN:0932-0067
1432-0711
DOI:10.1007/s00404-009-1020-5