Ultrasound guidance for vaginal drainage of postoperative pelvic hematoma: a case report

Postoperative pelvic fluid collection is almost a universal consequence of gynecologic surgery. At one end of the spectrum are minimal collections of peritoneal fluid or blood that are clinically inconsequential. At the other end are hematomas and abscesses requiring active intervention for the patient to recover.

This case report describes a symptomatic vaginal vault hematoma occurring after vaginal hysterectomy. Ultrasonography was used to accurately identify the hematoma and guide intraoperative drainage. The patient fully recovered without complication.

Accurate visual guidance of instrumentation to decompress postoperative retroperitoneal hematomas is a marked improvement over non-visual techniques utilizing palpation only. The hematoma cavity can be more easily entered and the hematoma or abscess more completely drained, expediting the recovery of the patient affected by this problem.