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An endometriotic vault fistula presenting with monthly bleeding after hysterectomy

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Abstract

Introduction

The aetiology of endometriosis remains unknown. The clinical presentation of endometriosis can be highly variable, occurring in numerous potential locations outside the abdomen and associated with distinct complaints. Recurrence is common, though we present a very rare case of recurrence and complication.

Case presentation

A 42-year-old caucasian woman was admitted to our unite with monthly vaginal bleeding lasting 3–5 days, beginning from 6 months after previous hysterectomy and right salpingo-oophorectomy surgery for myoma and endometrioma. We suspected of endometrioma of the left ovarium upon transvaginal ultrasonography, and diagnosed vault fistula from the endometriosis cyst to the vagina. We re-operated the patient using Pfannenstiel incision, and performed left-oophorectomy and fistula repairment. The Pouch of Douglas was obliterated and many bowel adhesions were present, indicating a stage IV endometriosis. According to our assessment, stage IV endometriosis had been present in the previous surgery.

Conclusions

Considering that the short-term endometriosis recurrence is higher in premenopausal age and in advanced stage of endometriosis, bilateral oophorectomy together with hysterectomy may be a better operational choice for these patients.

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Abbreviations

ALA:

5-Aminolevulinic acid

CA 125:

Marker of epithelial overian cancer and endometriosis

GnRH:

Gonodotrophin releasing hormone

USO:

Unilateral salpingo-oophorectomy

TAH:

Total abdominal hysterectomy

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Conflict of interest statement

Authors declare that they have no competing interests.

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Authors and Affiliations

  1. Istanbul University, Istanbul, Turkey

    Yavuz Aydin

  2. Third Obstetrics and Gynecology Department, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey

    Alev Atis & Melahat Donmez

  3. Medicana Hospital, Istanbul, Turkey

    Erdal Ercan

  4. Atakent Mahallesi, Olimpiakent Sitesi, D 12 Blok, D:31, Kucukcekmece, Istanbul, 34303, Turkey

    Yavuz Aydin

Authors
  1. Yavuz Aydin
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  2. Alev Atis
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  3. Erdal Ercan
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  4. Melahat Donmez
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Correspondence to Yavuz Aydin.

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Aydin, Y., Atis, A., Ercan, E. et al. An endometriotic vault fistula presenting with monthly bleeding after hysterectomy. Arch Gynecol Obstet 280, 1011–1014 (2009). https://doi.org/10.1007/s00404-009-1020-5

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  • DOI: https://doi.org/10.1007/s00404-009-1020-5

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