When endometriosis returns: managing vault involvement after hysterectomy: a case report

Anuvi Sinha, Tushar L. Rahane, Niteen Ghorpade
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 14(7) , pp. 2391–2394 · doi:10.18203/2320-1770.ijrcog20251998 · W4411679901
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This case report describes a 41-year-old patient with post-hysterectomy vault endometriosis successfully treated with laparoscopic excision of an endometriotic nodule and bladder serosal shaving.

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This case report describes a 41-year-old woman with irregular vaginal bleeding developing 7–8 years after a total laparoscopic hysterectomy, with a growth at the vaginal vault evaluated by biopsy and found to be suggestive of endometriosis. MRI was used to assess and rule out involvement of the bladder and rectum, followed by elective laparoscopic excision of an endometriotic nodule with bladder serosal shaving. The patient’s postoperative symptoms were relieved. As a single-patient report, the findings are limited to this clinical scenario. This paper is centrally about endometriosis — it reports management of post-hysterectomy vault endometriosis.

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Abstract

Vault endometriosis is a rare but quite challenging condition occurring in post-hysterectomy patients. Minimally invasive surgery remains the gold standard for the diagnosis and management of such cases. We hereby present a case report of a 41-year-old lady who had undergone total laparoscopic hysterectomy 12 years ago and came with irregular vaginal bleeding since 7 to 8 years. She was thoroughly evaluated for the same and underwent biopsy of the growth over the vault, which was suggestive of endometriosis. Magnetic resonance imaging (MRI) was done to rule out involvement of the bladder and rectum. She underwent elective laparoscopic excision of an endometriotic nodule over the vault and bladder serosal shaving. Postoperatively patient was relieved of her signs and symptoms.
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When endometriosis returns: managing vault involvement after hysterectomy: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20251998Keywords: Endometriosis, Vault, Vaginal bleeding, Nodule, Bladder, Bowel, HysterectomyAbstract Vault endometriosis is a rare but quite challenging condition occurring in post-hysterectomy patients. Minimally invasive surgery remains the gold standard for the diagnosis and management of such cases. We hereby present a case report of a 41-year-old lady who had undergone total laparoscopic hysterectomy 12 years ago and came with irregular vaginal bleeding since 7 to 8 years. She was thoroughly evaluated for the same and underwent biopsy of the growth over the vault, which was suggestive of endometriosis. Magnetic resonance imaging (MRI) was done to rule out involvement of the bladder and rectum. She underwent elective laparoscopic excision of an endometriotic nodule over the vault and bladder serosal shaving. Postoperatively patient was relieved of her signs and symptoms. Metrics References Pašalić E, Tambuwala MM, Hromić-Jahjefendić A. Endometriosis: Classification, pathophysiology, and treatment options. Pathol Res Pract. 2023;251:154847. DOI: https://doi.org/10.1016/j.prp.2023.154847 Limbachiya D, Tiwari R, Kumari R. Vault Endometriosis: Detailed Step-by-Step Laparoscopic Surgical Management Technique. JSLS. 2021;25(4):e2021.00057. DOI: https://doi.org/10.4293/JSLS.2021.00057 Choi CH, Kim JJ, Kim WY, Min KW, Kim DH. A rare case of post-hysterectomy vault site iatrogenic endometriosis. Obstet Gynecol Sci. 2015;58(4):319-22. DOI: https://doi.org/10.5468/ogs.2015.58.4.319 Yoga PP, Jacob OM, Sharmila V, Verma J. A Rare Case of Vaginal Vault Endometriosis in a Post Hysterectomised Woman: A Case Report. Indian J Obstet Gynecol. 2024;12(3):139-42. Markhani LR, Saluja N, Mothe S. Rare Case of Vaginal Bleeding with a Normal Vault following Surgical Menopause. Medico Res Chronicles. 2017;4(1):48-51. Working group of ESGE, ESHRE, and WES; Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open. 2020;2020(1):hoaa002. DOI: https://doi.org/10.1093/hropen/hoaa002 Sarkar A, Mahapatra M, Sahu A, Giri SK, Mallick RA. A Case Report of Post Hysterectomy Vault Endometriosis Managed with Laparoscopic Method. Pan Asian J Obs Gyn. 2022;5(1):41-4.

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