Prolapse of fallopian tube after abdominal hysterectomy

1120

Communications

in brief

was considered satisfactory because of the extensive lesions. The lesions were present before menarche. .A review of the literature failed to reveal any similar case in which con’dyloma acuminatum of the vulva was present for such a long period of time. The husband of 32 years and rhe only daughter, who was delivered vaginal]\, 24 years ago, are free of lesions. Modified simple vulvectomy is a necessary surgical treatment for extensive condyloma acuminatum. More cases like ours arc needed to he studied extcnsivclv lin possible association of extensive condyloma acumitlalum (of. long standing) and an underl$ng d(*fcc:t in immunity of the host. REFERENCES 1. Woodruff, J. D.: Diagnosis lesions of the vulva, curr.

and management of benign Probl. Obstet. Gvnecol. 1:31,

1978. 2. &ski, J, (I.. Reinhalter, malit& of lymphocyte condylomata acuminata,

E. R., and Silva, .J, .Jr.: Abnortransformations in women with Obstet. Gynecol. 51: 188. 1978.

Prolapse of fallopian tube after abdominal hysterectomy JOEL

NOVENDSTERN.

M.D.

vaginal cuff and pulled forward for ligation ant1 rl ntpurauo~~ Howevct~. a\ bleeding was noted c-oming from inridr of tht. vaginal cuff. the vaginal vault and pcritoncurrr I ‘.iallrlpi~n tuhc \\ith chronit \alpingitis and a torpus luteurn ( vst rrf the OXAI-~.” I’hc vaginal vault healed ~b.cll anti the patient is no\\ without byrnptoms. :I revict< of thr oprrafive report ot the total abdominal hysret-cac~orn! I-c~vealrd no operative ctrmplic-ations. -f‘hc al>trrior and pr)~tcrior edges of the vaginal c uffhas btretl sutured separatc’lv with a c,ontinuous interlocking chrtrmit i-0 stt
pain with the biops!, of grarlulation THIS

IS THE

ELEVENTH

reported

caseofa

prolapsed

fallopian tube into the vaginal vault after abdominal hysterectomy and the second case reported with concomitant ovarian cyst. A 25-year-old woman, gravida 2, para 2-O-O-2, underwent total adbominal hysterectomy for carcinoma in situ of the cervix. Eight months after hysterectomy the patient was seen with the complaints of a watery vaginal discharge, dyspareunia. intermittent lower abdominal pains, and postcoital bleeding. A pelvic examination had not been performed aftet hysterectomy as the patient failed to keep her appointment. On vaginal examination a 3 by 2 cm red, granular, polypoid mass was seen protruding from the center of the well-healed vaginal cuff. Bimanual pelvic examination was unsatisfactory because of guarding and scarring from three previous abdominal operations (two cesarean sections and the hysterectomy). ‘The initial impression was granulation tissue or a prolapsed fallopian tube. A punch biopsy was taken during which the patient experienced considerable discomfort and moderate bleeding. The latter was controlled by application of silver nitrate. Pathology of the biopsy specimen showed chronically inflamed granulation tissue. Suspicion of a prolapsed fallopian tube persisted and the patient was admitted to the hospital for an excisional vaginal biopsy. A general anesthetic was administered, and the prolapsed tube was separated from the

Reprint requests: Dr. Joel Novendstern, Group. Mount Kisco, New York 10549. 0005.437H/79/241120+01$0~.10/0

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normally The prolapse

majority ha\,c

of’ the occurred

tissue than ~\;ould

10 OCCUI-. repot,ted aftrr

cases vaginal

of

uterine tube hysterectomy.

This cast repot-t is unusual as none of thr predisposing factors for tubal prolapse. i.e.. postoperative fever, hematoma. profuse postoperative drainage \aginally. or drairts through the cul-dc-sac.. was present. I I is s@culative that the sizable o\ arian c.yst that developed after hystcrcr.tomy affected rhc tubal prolapse since it was a functional cyst; howcvcr. the c.oincidenc.r of‘ovarian cyst and tubal prolapse must bc nored and has (I(‘curred oncr prrviollsly in 1hf. 10 c’asrs t-cpot ttxl in tht*

literature.’ In summar), prolapse of’ the fallopian tube is ;I rare occurrence’ follt)wing at~clotnirml h~stcrtctorny: horlever, the diagnosis should not t,c. missed. .l‘he possibility of a concomitant ovarian cyst occurring \+itll tubal prolapse has now been reported twice. ‘I‘he gynecolngit surgeon should be allare of’ this rvhcn rhe tubal prolapse is correctrd 1~): vaginal surger!. REFERENCES I. Smout, (:. F. V.. Jacoby, F., and Lillie, F. W.: Cynaecological and Obstetrical Anatomy, ed. 4, Baltimore. 1969, The Williams & Wilkins Company, p. 339. 2. Hirsch, H., and Wyatt, L.: Prolapse of Fallopian tube after abdominalhysterectomy, AM~J.OBS.~ET.GYNEC~OL.~%~:QQ~. 1961.

(:I,

be expected