Hématome infecté du cul-de-sac de Douglas : une complication spécifique de la chirurgie de l’endométriose profonde postérieure du fond vaginal

Sanguin S, S. Sanguin, Horace Roman, H. Roman, Roman H, M. Vassilieff, Vassilieff M, Bridoux V, Valérie Bridoux, V Bridoux, Da Costa C, Clive Da Costa, C. da Costa, Cécile Martin, Martin C, C Martin, Marpeau L, L. Marpeau, L Puscasiu, Puscasiu L, Lucian Pușcașiu
Gynecologie, obstetrique & fertilite · 2013 · vol. 41(3) , pp. 149–155 · doi:10.1016/j.gyobfe.2013.01.005 · PMID:23498726 · W2002172126
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This paper describes infected hematoma of the rectouterine pouch as a specific complication following deep posterior endometriosis surgery at the vaginal vault.

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Abstract

ObjectiveSurgical management of deep pelvic endometriosis may be responsible for various complications, such as infected pelvic haematic collection of the Douglas pouch. The aim of this study is to describe this unfavourable outcome and to estimate its frequency in the series of women managed by our team.Patients and methodsRetrospective study enrolling 163 women undergoing surgical removal of deep posterior endometriosis involving the vagina, from January 2008 to September 2011. We indentified women presenting with postoperative fever associated with computed tomographic findings suggesting an abscess of the Douglas pouch. Women characteristics, complication's management and outcomes were analysed in each case.ResultsTen patients presented an inflammatory syndrome associated to hypothetical Douglas pouch abscess, revealed 6 days postoperatively on average. All women reported increasing pelvic pain, fever higher than 38.5°C, increased level of leucocytes and C reactive protein, and liquid collection of the Douglas pouch. Surgical management was carried out in nine women, revealing a pelvic collection of cloudy haematic liquid. Various bacteria were identified in six cases out of nine, suggesting liquid contamination through vagina opening. Postoperative outcome were immediately favourable.Discussion and conclusionInflammatory syndrome associated with infected haematic collection of the Douglas pouch is a postoperative complication of the surgical removal of deep endometriosis involving the posterior vagina. Surgical removal of the haematic collection allows rapid and definitive favourable outcomes.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Bacterial Infections Douglas' Pouch Endometriosis Hematoma Postoperative Complications Vaginal Diseases Adult Bacterial Infections Endometriosis Female Hematoma Humans Middle Aged Pelvic Pain Peritoneal Diseases Postoperative Complications Retrospective Studies Vaginal Diseases

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