Development of endosalpingoblastosis and tuboperitoneal fistulas following tubal sterilization: relation with uterine adenomyosis

A P Maker, A.Ph. Maker, Maker AP, Keersmaekers GH, G H Keersmaekers, Vanderheyden JS, J S Vanderheyden, Hänsch C, Ch. Hansch, C Hänsch
European journal of obstetrics, gynecology, and reproductive biology · 1993 · vol. 52(3) , pp. 187–191 · doi:10.1016/0028-2243(93)90070-s · PMID:8163034 · W2009564351
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This case report describes endosalpingoblastosis and tuboperitoneal fistulas in a patient with uterine adenomyosis, observed after tubal sterilization.

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Abstract

A total of 25 consecutive patients who had undergone a tubal sterilization and who were referred for a hysterectomy, were examined by a peroperative methylene blue test of the tubal stumps, and extensive microscopic examination of the uterine wall, cornua and tubal stumps. Eighteen patients had been sterilized by electrocoagulation and 7 by mechanical methods (clips or rings). Tubo- or uteroperitoneal fistulas and endosalpingoblastosis were only observed in the group of patients sterilized by electrocoagulation. The development of tubo- or uteroperitoneal fistulas was correlated with the presence of endosalpingoblastosis and of uterine adenomyosis (P = 0.002 and P = 0.038, respectively). All patients with bilateral fistulas had bilateral endosalpingoblastosis and the only patient with a unilateral fistula had endosalpingoblastosis on the same side. The development of endosalpingoblastosis in patients sterilized by electrocoagulation was correlated with the presence of uterine adenomyosis (P = 0.008). In the same group of patients, a correlation between the length of the proximal tubal stump and the development of utero- or tuboperitoneal fistulas was observed (Wilcoxon test, P = 0.033). Two patients developed an ectopic pregnancy following sterilization. Both patients were sterilized by electrocoagulation, and had endosalpingoblastosis and bilateral fistulas. Our results suggest that the presence of uterine adenomyosis might predispose to the development of endosalpingoblastosis when performing tubal electrocoagulation close to the uterine cornum. We therefore suggest that when performing tubal coagulation, the intact proximal stump should be at least 2 cm.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Fallopian Tube Diseases Fistula Sterilization, Tubal Uterine Diseases Adult Endometriosis Fallopian Tube Diseases Female Fistula Humans Middle Aged Peritoneum Sterilization, Tubal Uterine Diseases

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