Abstract

A 29 Year old Patient with history of vaginal hysterectomy done 8 months back presented with monthly cyclical pain in abdomen and bleeding per vaginum. The patient was investigated and posted for exploratory laparotomy. Uterine remnants (fundus and Body) were removed with right salpingoophorectomy.

Introduction

Most of the Gynaecologists must have come across cases of ovarian remnant1 or residual ovary syndrome1 but with reference to available literature it has been observed that uterine remnants after hysterectomy are very rare. We noted a case presented with complaints of monthly cyclical pain in lower abdomen, bleeding per vaginum with history of vaginal hysteretomy done. Patient was investigated thoroughly, diagnosis of uterine remanats confirmed and than she was taken for exploratory laparotomy where uterine remnant were removed.

Case History

A 29 year old patient Mrs. XYZ Para 3, Living 3 with history of vaginal hysterectomy done 8 months back for fibroid uterus with menorrhagia, presented with chief complaints of monthly cyclical pain in lower abdomen, bleeding per vaginum since 7 months and ultrasonography showing evidence of uterine remnant of 5 cm x 3 cm adherent to superior surface of bladder and two small loculated cysts of 6 x 6 cms in pouch of Douglas with bowel loops adherent to it.

Patient gave history of being operated at a private nursing home in Hyderabad, the discharge card of same mentioned that there was some difficulty in negotiating the anterior vaginal pouch, but the procedure was complete, conserving both tubes and ovary. Histopathological report confirmed the completeness of procedure, although it mentions that the sample was received in piecemeal condition.

Patient’s obstetric history consisted of previous 3 full term lower segment cesarean sections.

CT Scan confirmed the diagnosis of uterine remnant. Patient was explored after taking medical fitness in view of patient being a known case of allergic rhinitis.

Intraoperative Findings

PIntraoperative findings are given below as shown in the respective Diagrams.

Uterine remnants (Fundus and Body) was removed with Rt. Salphingoophorectomy, Left tube and ovary was conserved. Postoperative course was uneventful and patient was discharged on day 5 of the surgery.

Fig. 1 : Anterior view - showing fundus and body of uterus (6 x 4 cm) with Rt tuboovarian mass (10 x 8 cm) left adnexa adhered on anterior abdominal wall.		Fig. 2 : Posterior view showing normal left tube ovary, fundus and body of uterus and right tuboovarian mass.

Discussion

It is not infrequent to encounter a patient with history of 3 LSCS in modern obstetrics for hysterectomy. Although it would be prudent to presume that abdominal approach is better but the final decision should rest with the operative surgeon. If vaginal approach is contemplated, one should not hesitate to abandon the same for abdominal at any point of surgery, if difficulty arises. In such cases adhesions are to be expected with both the bladder and bowel, therefore it would be judicious to perform preoperative CT scan and to ask for surgeon standby

References

1. Teelind, Textbook of gynaecology; Ovarian remnant syndrome and Ovarian Residual Syndrome, page 647-8.
   

*Associate Professor, **Resident, Department of Ophthalmology, T.N.M.C and B.Y.L. Nair Hospital, Mumbai - 400 008.