{"paper_id":"5540966b-1707-43fe-a9a5-c4a93e2f2335","body_text":"C A S E R E P O R T Open Access\nProlapse of fallopian tube through\nabdominal wound after caesarean\nsection mimicking scar endometriosis: a\ncase report\nLajya Devi Goyal 1, Shalini Maheshwari 1, Sharanjit Kaur 2* and Harpreet Kaur 1\nAbstract\nIntroduction: Prolapse of the fallopian tube after hysterectomy is a rare but known complication. Cases of prolapse\nof the fallopian tube through the vaginal vault have been reported after abdominal, vaginal or laparoscopic\nhysterectomies. This is the first case report to the best of our knowledge on the prolapse of a fallopian tube\nthrough an abdominal wound after caesarean section.\nCase presentation: We report a case of the prolapse of the fimbrial end of a fallopian tube through an abdominal\nscar after caesarean section mimicking scar endometriosis. A 24-year-old primipara South Asian woman of Punjabi\nethnicity presented to our institute with a fleshy mass protruding through her abdominal scar and bleeding from\nthe mass during menstruation for the past 5 months. She underwent a caesarean section 6 months earlier for\nbreech presentation. Her history revealed she had wound dehiscence on the sixth postoperative day. The major\nportion of her wound healed in 1 month leaving a 2 cm area in the middle of her vertical scar. An abdominal\nexamination revealed a 2×2 cm fleshy mass protruding through the middle part of her infraumbilical abdominal\nscar. At the time of the surgery we found that the fimbrial end of her left fallopian tube was protruding through\nher abdominal scar.\nConclusion: Awareness of this complication may prevent improper management of wound dehiscence and such\ncomplication causing prolonged agony to the patient.\nKeywords: Fallopian tube, Prolapse, Scar endometriosis\nIntroduction\nProlapse of the fallopian tube after hysterectomy is a\nrare but known complication. Cases of prolapse of\nthe fallopian tube through the vaginal vault have been\nreported after abdominal, vaginal or laparoscopic\nhysterectomies [1 –3]. We report a case of prolapsed\nfimbrial end of the fallopian tube through an abdominal\nscar after caesarean section which mimicked scar\nendometriosis and is very unusual. This is the first\ncase report to the best of our knowledge on the pro-\nlapse of a fallopian tube through an abdominal wound\nafter caesarean section.\nCase presentation\nA 24-year-old South Asian woman of Punjabi ethnicity pre-\nsented with fleshy mass protruding through midline vertical\nabdominal scar and bleeding from the mass during men-\nstruation for the past 5 months. She was primigravida; she\nunderwent a caesarean secti on 6 months earlier at term\ngestation for breech presentation in a local hospital. She de-\nlivered a normal healthy baby boy and the immediate post-\npartum period was uneventful. On the sixth postoperative\nday she noticed serosanguinous discharge from her abdom-\ninal wound and wound dehiscence was diagnosed. She was\nmanaged conservatively and the wound was left for second-\nary healing by the attending physician. Her history revealed\nthat she was given antibiotic coverage during this time. The\nmajor portion of her wound healed in 1 month leaving a 2\n* Correspondence: jitsharan28@gmail.com\n2University Collège of Nursing, Faridkot, Punjab 151203, India\nFull list of author information is available at the end of the article\n© 2015 Goyal et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0\nInternational License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and\nreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to\nthe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver\n(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.\nGoyal et al. Journal of Medical Case Reports  (2015) 9:280 \nDOI 10.1186/s13256-015-0769-3\n\ncm area in the middle of her vertical scar. An investigation\nat the time of her caesarean section revealed that she was\nanemic (hemoglobin 8 gm %). Peripheral blood film re-\nvealed microcytic hypochromic anemia. On admission\nto our institute she was emaciated, thin built, anemic\nand her vital signs were normal. An abdominal exam-\nination revealed a 2×2 cm fleshy mass protruding\nthrough the middle part of her infraumbilical abdom-\ninal scar. On per vaginal examination her uterus\nseemed attached to the anterior abdominal wall at the\nscar site and with cervical movement the mass was\ngetting retracted into her abdomen. With her history\nof menstruation through the abdominal wound a\nprovisional diagnosis of scar endometriosis/uterocuta-\nneous fistula was made and ultrasonography (USG)\nand fistulogram were suggested. USG showed normal\nuterus and adnexa and fistulogram showed communi-\ncation with intraperitoneal cavity. A tissue biopsy re-\nvealed granuloma. She was planned for excision of\nthe fistula tract and repair. On an operating table\nmethylene blue dye was injected through the wound\nto mark the fistulous tract and dye was found to be\nescaping through her vagina confirming communica-\ntion with uterine cavity. An elliptical incision was\nm a d ea r o u n dt h ef l e s h ym a s sa n do ne n t e r i n gt h ea b -\ndominal cavity, the left side of her uterus was adher-\nent with her anterior abdominal wall at the scar site\nand the fimbrial end of her left fallopian tube was\nfound to be protruding through the abdominal scar.\nA probe (dilator) was passed through the tube and\ndiagnosis was confirmed (Fig. 1). The tube was pulled\ninside and adhesiolysis of uterine adhesions from an-\nterior abdominal wall was done. The scar edges were\nfreshened and the incision was closed in layers. She\nhad an uneventful recovery. She was followed up\nmonthly for 3 months and had no complaints.\nDiscussion\nPozzi in 1902 described the first report of postoperative\nprolapse of fallopian tube after vaginal hysterectomy [4].\nSince then, there have been approximately 100 case\nreports of prolapse of fallopian tube after hysterectomy\nand the prevalence after hysterectomy is reported to be\napproximately 0.3 % [5]. There is no literature to the\nbest of our knowledge on prolapsed fimbrial end of the\nfallopian tube through caesarean section wound.\nThere could be multiple predisposing factors that lead\nto fallopian tube prolapse. Ouldamer et al .[ 6 ]d i da\nsystemic review on prolapse of fallopian tube after\nhysterectomy and suggested multiple contributing\nfactors including defective operative technique, poor\nnutritional status, pelvic infection, wound hematoma,\nuncontrolled diabetes, chronic cough and constipation.\nThe poor physical status of the patient, anemia\nmalnutrition, postoperative wound infection and letting\nthe wound heal by secondary intention could have been\nthe contributing factors in this case. Diagnosis at the time\nof postoperative wound disruption was probably missed.\nIn this case the symptoms mimicked scar endometriosis\nbecause it typically presented after caesarean section and\nthere was menstrual bleeding through the wound. The dif-\nferential diagnosis in such cases includes scar endometri-\nosis, uterocutaneous fistula and wound granuloma. We\nhave reported six cases of scar endometriosis with similar\nfindings [7]; however, fallopian tube tissue is firmer than\ngranulomatous and endometriotic tissue. The easy passage\nof a probe into the lumen of the fallopian tube may aid in\nestablishing the diagnosis as in our case. Management de-\npends on the presence of infected tissue on the exposed\nend. Partial or total salpingectomy may be required. In\nour index case, the fallopian tube was healthy so we\ncleaned the fimbrial end thoroughly and replaced it in the\nabdominal cavity.\nConclusions\nPrevention of tubal prolapse can be achieved by improv-\ning the general condition of the patient and treating\nanemia and infections during the pregnancy, using a\nproper technique of wound closure at the time of\nprimary surgery and careful inspection in the case of\nwound dehiscence for burst abdomen. Awareness of\nthis complication may prevent inadequate treatment\nof wound dehiscence and such complication causing\nagony in the patient ’s life.\nFig. 1 Intraoperative photograph showing prolapsed fallopian tube\nthrough abdominal wound\nGoyal et al. Journal of Medical Case Reports  (2015) 9:280 Page 2 of 3\n\nConsent\nWritten informed consent was obtained from our patient\nfor the publication of this case report and any accompany-\ning images. A copy of the written consent is available for\nreview by the Editor-in-Chief of this journal.\nCompeting interests\nThe authors declare that they have no competing interests.\nAuthors’ contributions\nLDG admitted the patient and she along with HK operated the case. SM\nhelped in writing the manuscript, manuscript submission and modifications\nwere carried out by SK. All authors read and approved the final manuscript.\nAcknowledgements\nThe authors have no support or funding to report.\nAuthor details\n1Department of Obstetrics and Gynaecology, Gurugobind Singh Médical\nHospital, Faridkot, Punjab 151203, India. 2University Collège of Nursing,\nFaridkot, Punjab 151203, India.\nReceived: 13 March 2015 Accepted: 17 November 2015\nReferences\n1. De Clippel K, Coenen M, Bhal PS, Amso N. Fallopian tube prolapse following\nabdominal hysterectomy. Aust N Z J Obstet Gynaecol. 2001;41(1):106 –8.\ndoi:10.1111/j.1479-828X.2001.tb01307. PubMed: 11284638.\n2. Sanklecha VM, Sisodia SM, Ansari SAH, Pol S. Posthysterectomy fallopian\ntube prolapse. J Midlife Health. 2012;3(1):40 –1. doi:10.4103/0976-7800.98817.\n3. Caceres A, McCarus SD. Fallopian tube prolapse after total laparoscopic\nhysterectomy. Obstet Gynecol. 2008;112(2 Pt 2):494 –5. PubMed: 18669777.\n4. Pozzi M. Hernie de la trompe dans le vagin au niveau de la cicatrice\nopératoire d ’hystérectomie vaginale. C R Soc Obstet Gynecol Paediat Paris.\n1902;4:255–7.\n5. Fan QB, Liu ZF, Lang JH, Sun DW, Leng JH, Zhu L, et al. Fallopian tube\nprolapse following hysterectomy. Chin Med Sci J. 2006;21(1):20 –3.\nPubMed: 16615279.\n6. Ouldamer L, Caille A, Body G. Fallopian tube prolapsed after hysterectomy: a\nsystemic review. PLoS One. 2013;8(10):e76543. doi:10.1371/journal.pone.0076543.\n7. Goel P, Devi L, Tandon R, Saha PK, Dalal A. Scar endometriosis – a series of\nsix patients. Int J Surg. 2011;9(1):39 –40. doi:10.1016/j.ijsu.2010.08.003.\n•  We accept pre-submission inquiries \n  Our selector tool helps you to find the most relevant journal\n  We provide round the clock customer support \n  Convenient online submission\n  Thorough peer review\n  Inclusion in PubMed and all major indexing services \n  Maximum visibility for your research\nSubmit your manuscript at\nwww.biomedcentral.com/submit\nSubmit your next manuscript to BioMed Central \nand we will help you at every step:\nGoyal et al. Journal of Medical Case Reports  (2015) 9:280 Page 3 of 3","source_license":"CC0","license_restricted":false}