Abstract:

This report presents an exceptional case of uterine avulsion following a cold-knife conization, an unprecedented surgical complication of a common gynecological procedure. Furthermore, it describes the outcomes of the conservative laparoscopic reconstruction that was performed. A 30-year-old nulliparous was referred to our department with secondary amenorrhea and cyclic pelvic pain following a cold-knife conization performed 9 months previous in another institution. The patient underwent a diagnostic laparoscopy, which confirmed that the cervix had been completely resected and that the uterine and vaginal cavities were no longer in contact. We performed an end-to-end utero-vaginal anastomosis followed by a prophylactic cerclage. No intraoperative or postoperative complications were observed. One month after surgery the patient was asymptomatic with normal withdrawal bleeding and remained asymptomatic during her 12-month follow-up consult. To our knowledge, this is the first time that this serious complication with a potential for irreversible damage to reproductive function is reported as a complication of cervical conization. Although our conservative surgical correction repaired the anatomy and reestablished menstruation outflow, further follow-up is necessary to confirm the extent to which reproductive function was restored.

Authors:

Samuel Santos-Ribeiro, MD, Resident, Obstetrics and Gynecology, Ana Coelho, MD, Assistant, Obstetrics and Gynecology, Teresa Diniz da Costa, MD, Assistant, Obstetrics and Gynecology, Sónia Barata, MD, Assistant, Obstetrics and Gynecology, Conceição Alho, MD, Senior Assistant, Obstetrics and Gynecology, Filipa Osório, MD, Assistant, Obstetrics and Gynecology, Carlos Calhaz-Jorge, MD, PhD, Coordinator, Service of Gynecology, Obstetrics and Gynecology Department, University Hospital of Santa Maria, Lisbon, Portugal

PMID:  24532481

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