An endometriotic vault fistula presenting with monthly bleeding after hysterectomy

The aetiology of endometriosis remains unknown. The clinical presentation of endometriosis can be highly variable, occurring in numerous potential locations outside the abdomen and associated with distinct complaints. Recurrence is common, though we present a very rare case of recurrence and complication.

A 42-year-old caucasian woman was admitted to our unite with monthly vaginal bleeding lasting 3-5 days, beginning from 6 months after previous hysterectomy and right salpingo-oophorectomy surgery for myoma and endometrioma. We suspected of endometrioma of the left ovarium upon transvaginal ultrasonography, and diagnosed vault fistula from the endometriosis cyst to the vagina. We re-operated the patient using Pfannenstiel incision, and performed left-oophorectomy and fistula repairment. The Pouch of Douglas was obliterated and many bowel adhesions were present, indicating a stage IV endometriosis. According to our assessment, stage IV endometriosis had been present in the previous surgery.

Considering that the short-term endometriosis recurrence is higher in premenopausal age and in advanced stage of endometriosis, bilateral oophorectomy together with hysterectomy may be a better operational choice for these patients.