IATROGENIC ENDOMETRIOSIS OF THE VAGINAL VAULT FOLLOWING A TOTAL LAPAROSCOPIC HYSTERECTOMY

Rebecca Llewellyn-Bennett, Krishen Sieunnaire
In: West London medical journal · 2010 · vol. 2(4) , pp. 1–4 · W1603188293
article OA: closed CC0 ⤵ 2 in-corpus citations Metadata only
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A vaginal vault nodule diagnosed as endometriosis 18 months after laparoscopic hysterectomy was attributed to iatrogenic seeding from uterine morcellation.

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Abstract

Background: Iatrogenic pelvic endometriosis is a rare complication of laparoscopic surgery. Pelvic seeding of endometrial tissue following uterine morcellation has been previously reported. This case describes endometriosis of the vaginal vault secondary to morcellation of the uterus. Case Report: A 45-year old lady underwent a total laparoscopic hysterectomy for menorrhagia and a multiple fibroid uterus where no endometriosis was evident in the pelvis. The uterus was morcellated and removed via the vagina. Histopathology of the uterus did not show adenomyosis nor endometriosis. Eighteen months later, she presented with mild, regular cyclical bleeding. On examination, there was an abnormal epithelial nodule in the vaginal vault, which was subsequently excised. Histology revealed features consistent with endometriosis. Discussion : The formation of an endometriotic nodule could have resulted from inadvertent seeding and implantation as a consequence of the uterine morcellator used during laparoscopic hysterectomy. Abdominal or vaginal vault spillage during uterine morcellation should always be minimized and vigorous irrigation of the pelvis is recommended.

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endometriosisadenomyosis

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