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

• Published in: Surgical technology international Vol. 24; p. 231
• Main Authors: Santos-Ribeiro, Samuel, Coelho, Ana, da Costa, Teresa Diniz, Barata, Sónia, Alho, Conceição, Osório, Filipa, Calhaz-Jorge, Carlos
• Format: Magazine Article
• Language: English
• Published: United States 01.03.2014
• Subjects: 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
• ISSN: 1090-3941

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.