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      Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report

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          Abstract

          Background

          Iatrogenic endometriosis is the presence of endometrial glands and stroma out of the uterus following certain surgical interventions. The rate of iatrogenic endometriosis after gynecologic surgeries due to benign uterine disease is 1–2%. Laparoscopic supracervical hysterectomy is also a part of frequently used surgical treatment of apical pelvic organ prolapse, which is followed by sacrocervicopexy. However, there are no data about iatrogenic endometriosis after apical prolapse surgery in the current literature. Herein, we present a case report of a patient diagnosed with de novo endometriosis 1 year after laparoscopic supracervical hysterectomy and sacrocervicopexy.

          Case presentation

          A 46-year-old parous Slavic woman who underwent laparoscopic supracervical hysterectomy and sacrocervicopexy secondary to grade 3 symptomatic apical prolapse 1 year earlier was admitted to the same clinic with pelvic pain that had started 6 months following surgery. Deep vaginal palpation was painful. Transvaginal ultrasonography revealed an area with hypervascularization on the sacral promontory. She was scheduled for diagnostic laparoscopy. A 2 × 2-cm solid, wine-colored, hypervascular hemorrhagic lesion was seen on the sacral promontory. The lesion and the peritoneal layer behind it were totally excised. The patient was discharged on the first postoperative day, without any complications. Pathologic examination revealed foci of endometriosis comprising endometrial glands and stroma within the connective tissue, along with hemosiderin-laden macrophages. The symptoms of the patient resolved after the surgery, and no further adjuvant treatment was needed.

          Conclusion

          Although the rate of iatrogenic endometriosis is low after laparoscopic supracervical hysterectomy and sacrocervicopexy, the possibility of the occurrence of iatrogenic endometriosis should be discussed with patients who are diagnosed with apical prolapse to determine the type of surgical intervention. Iatrogenic endometriosis should be kept in mind for differential diagnosis in case of pain after laparoscopic supracervical hysterectomy and sacrocervicopexy.

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          Most cited references 14

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          Nationwide trends in the performance of inpatient hysterectomy in the United States.

          To examine the use of inpatient hysterectomy and explore changes in the use of various routes of hysterectomy and patterns of referral.
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            A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse.

            Abdominal sacrocolpopexy (ASC) represents the superior treatment for apical pelvic organ prolapse (POP) but is associated with increased length of stay, analgesic requirement, and cost compared with transvaginal procedures. Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) may offer shorter postoperative recovery while maintaining equivalent rates of cure.
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              Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity.

               E Wight,  U Haller,  Y Tadir (1993)
              The extraction of large tissue masses from the abdominal cavity during laparoscopic surgery is a time-consuming, complicated process. A new prototype instrument is introduced that allows quick laparoscopic removal of fibromas, ovaries, or other tissues from the abdomen. A cylinder with a coning knife at its intra-abdominal end is placed inside the trocar sleeve and is rotated by an electrical micro-engine attached to the trocar. Cylindrical tissue blocks are cut step by step out of the main specimen and removed from the peritoneal cavity through the sleeve with a grasping forceps. Tissue removed is suitable for histologic examination. The principal application is morcellation of fibromas, whereas use in ovarian disease is limited. This new device provides a safe and effective approach inside the abdominal cavity.
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                Author and article information

                Contributors
                alkancubuk@hotmail.com
                ozkaptanorkunt@gmail.com
                joerg.neymeyer@charite.de
                Journal
                J Med Case Rep
                J Med Case Rep
                Journal of Medical Case Reports
                BioMed Central (London )
                1752-1947
                5 January 2020
                5 January 2020
                2020
                : 14
                Affiliations
                [1 ]Department of Urology, Kartal Dr. Lütfi Kırdar Traning and Research Hospital, Istanbul, Turkey
                [2 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Department of Urology, , Charité Universitätsmedizin Berlin, ; Berlin, Germany
                Article
                2327
                10.1186/s13256-019-2327-x
                6942662
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Case Report
                Custom metadata
                © The Author(s) 2020

                Medicine

                hysterectomy, laparoscopy, pelvic organ prolapse, endometriosis

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