Obstet Gynecol Sci.  2015 Jul;58(4):319-322. 10.5468/ogs.2015.58.4.319.

A rare case of post-hysterectomy vault site iatrogenic endometriosis

• Choi CH
• Kim JJ
• Kim WY
• Min KW
• Kim DH

• KMID: 2314054
• DOI: http://doi.org/10.5468/ogs.2015.58.4.319

Abstract

A 45-year-old woman with a prior history of hysterectomy due to adenomyosis and leiomyomas was presented at our outpatient gynecology clinic 13 months later with sudden lower pelvic discomfort and vaginal bleeding symptoms. The patient underwent vaginal vault biopsy however diagnosis was still uncertain. Additional evaluation was required due to massive rebleeding incidents. After an emergent explorative laparoscopic operation with total excision of the vault, a diagnosis of vaginal vault endometriosis was made. Our theory is that a possible transplantation of endometrial cells during morcellation of the adenomyotic uterus which then may have progressed to iatrogenic endometriosis of the vaginal vault. Therefore, vault endometriosis must be considered in incidences of delayed massive bleeding occurring in post-hysterectomy patients when other diagnoses have been excluded.

Keyword

Hysterectomy; Morcellation; Vagina vault endometriosis

MeSH Terms

Adenomyosis
Biopsy
Diagnosis
Endometriosis*
Female
Gynecology
Hemorrhage
Humans
Hysterectomy
Incidence
Leiomyoma
Middle Aged
Outpatients
Uterine Hemorrhage
Uterus

Figure

• 

  Fig. 1 Wine colored lesion on vault site at initial pelvic examination.

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  Fig. 2 (A) Initial biopsy of the vault lesion showing unusual cells at the surface with sub-epithelial hemorrhage (H&E, ×40, ×200). S14-41234, vagina, loss of surface epthelium with subepithelial hemorrhage. (B) The microscopic section of vaginal vault showing typical endometriosis (H&E, ×40, ×200). S14-42249, vaginal vault, C/W endometriosis. C/W; compatible with

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