Post-hysterectomy menstruation: a rare phenomenon

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This case report presents vault endometriosis as a rare cause of bleeding after hysterectomy, emphasizing its consideration in differential diagnoses.

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This paper describes post-hysterectomy bleeding, a rare phenomenon, reviewing that such bleeding has varied causes including atrophic vaginitis, cervical stump cancer, infiltrating ovarian tumors, estrogen-secreting tumors elsewhere, bowel diverticulitis with fistula, and bladder pathology. It highlights that endometriosis of the vaginal vault can also cause post-menopausal bleeding and presents a rare case of vault endometriosis causing menstruation-like bleeding after hysterectomy. The main caveat is that the evidence presented is essentially descriptive and case-based rather than from a systematic study, limiting generalizability. Relevance to endometriosis: the authors explicitly discuss vault endometriosis as a differential diagnosis for bleeding after hysterectomy, stating it can cause post-menopausal bleeding, though the paper is chiefly a rare case report/phenomenon review rather than a broad endometriosis investigation.

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Abstract

Post-menopausal bleeding is a common problem with varied etiology in the age group between 50 and 60 years. It is more likely to be of some pathologic cause which needs to be ruled out. Bleeding in a patient after hysterectomy is even rarer with varied causes like atrophic vaginitis, cervical stump cancer, infiltrating ovarian tumors, estrogen secreting tumors in other parts of the body. Endometriosis of the vault sometimes can cause post-menopausal bleeding. Diverticulitis of the bowel may give rise to vaginal discharge due to fistula, but bleeding is rare. Bladder pathology may cause vaginal bleeding. Our case is a rare case of vault endometriosis and should always be kept as a differential diagnosis in patients with bleeding after hysterectomy.
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Abstract

Post-menopausal bleeding is a common problem with varied etiology in the age group between 50 and 60 years. It is more likely to be of some pathologic cause which needs to be ruled out. Bleeding in a patient after hysterectomy is even rarer with varied causes like atrophic vaginitis, cervical stump cancer, infiltrating ovarian tumors, estrogen secreting tumors in other parts of the body. Endometriosis of the vault sometimes can cause post-menopausal bleeding. Diverticulitis of the bowel may give rise to vaginal discharge due to fistula, but bleeding is rare. Bladder pathology may cause vaginal bleeding. Our case is a rare case of vault endometriosis and should always be kept as a differential diagnosis in patients with bleeding after hysterectomy.

References

Saropala N, Ingsirorat C (1998) Conservative treatment of vaginal vault granulation tissue following total abdominal hysterectomy. Int J Gynaecol Obstet 62(1):55–58 Ramin SM, Ramin KD, Hemsell DL (1999) Fallopian tube prolapse after hysterectomy. South Med J 92(10):963–966 Oliver R, Coker A, Khoo D (2006) Laparoscopic approach to an endometriotic vault fistula causing posthysterectomy menstruation. J Minim Invasive Gynecol 13(2):164–165 Ehlen T, Randhawa G, Turko M, Clement PB (1989) Posthysterectomy carcinoma of the fallopian tube presenting as vaginal adenocarcinoma: a case report. Gynecol Oncol 33(3):382–385 Vercellini P, Frontino G, Pietropaolo G, Gattei U, Daguati R, Crosignani PG (2004) Deep endometriosis: definition, pathogenesis, and clinical management. J Am Assoc Gynecol Laparosc 11(2):153–161 Fatemi HM, Al-Turki HA, Papanikolaou EG, Kosmas L, De Sutter P, Devroey P (2005) Successful treatment of an aggressive recurrent post-menopausal endometriosis with an aromatase inhibitor. Reprod Biomed Online 11(4):455–457 Aydin Y, Atis A, Ercan E, Donmez M (2009) An endometriotic vault fistula presenting with monthly bleeding after hysterectomy. Arch Gynecol Obstet; 24 (Epub ahead of printing) Conflict of interest statement None. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Lyngdoh, B.T., Kriplani, A., Garg, P. et al. Post-hysterectomy menstruation: a rare phenomenon. Arch Gynecol Obstet 281, 307–309 (2010). https://doi.org/10.1007/s00404-009-1173-2 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-009-1173-2

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Hysterectomy Menstruation Endometriosis Endometriosis Female Histocytochemistry Humans Menstruation Middle Aged

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