A rare case of post-hysterectomy vault site iatrogenic endometriosis

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.

Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report

“…In a review by Kızılay et al, it was suggested that the treatment of endometriosis aims at pain relief, preserving fertility, and preventing obstruction [7]. Oral contraceptive drugs, analgesic drugs, gonadotropin-releasing hormone agonists, and aromatase inhibitors are the firstline medical treatment options [3]. Surgical excision is usually necessary to preserve fertility and to treat urinary obstruction related to endometriosis [7].…”

“…Surgical excision is usually necessary to preserve fertility and to treat urinary obstruction related to endometriosis [7]. When it comes to IE, there is no specific treatment algorithm in the literature; however, surgical excision has been discussed as the first treatment option by authors [3][4][5]. In accordance with the literature, diagnostic laparoscopy and excision of endometriosis was our preferred treatment modality.…”

“…Iatrogenic endometriosis (IE) is the presence of endometrial glands and stroma out of the uterus following certain surgical interventions, such as total or supracervical hysterectomy, myomectomy, and cesarean section [1]. The most common localizations for IE are cesarean scares (skin scare, uterus scare), trocar sites, sigmoid colon, ovaries, bladder, vaginal vault, and the parietal peritoneum [2,3]. Pain, dyspareunia, bleeding, and palpable mass are the common symptoms of IE.…”

Iatrogenic Endometriosis after Laparoscopic Hysterectomy with Vaginal Power Morcellation: A Case Report

“…The remaining 30% appears spontaneously. The reported prevalence of this condition is 3.5-5.5% of all cases of endometriosis and its incidence seems to be increasing nowadays [6][7][8][9].…”

Vault Endometriosis: Detailed Step-by-Step Laparoscopic Surgical Management Technique

“…These remnant endometriotic tissue may regrow at the vault leading to symptomatology. 3 It may also be referred to as a form of iatrogenic endometriosis, 3 which is the presence of endometriotic tissue following specific gynecologic surgical interventions in case of benign uterine disease. Vault endometriosis can spread locally over time, leading to severe symptoms as chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and can involve adjacent structures gradually leading to grave complications as the involvement of bladder leads to hematuria, involvement of bowel leads to hematochezia and ureter involvement which leads to dreadful consequences like hydroureter, hydronephrosis, or even kidney failure, 4 , 5 and peritonitis.…”