Laparoscopic re-anastomosis of a uterine avulsion following cold-knife conization

Surg Technol Int. 2014 Mar:24:231-5.

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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anastomosis, Surgical
  • Cervix Uteri / diagnostic imaging
  • Cervix Uteri / pathology
  • Cervix Uteri / surgery*
  • Conization / adverse effects*
  • Female
  • Hematometra / diagnostic imaging
  • Hematometra / surgery
  • Humans
  • Laparoscopy / methods*
  • Uterus / surgery
  • Vagina / surgery