An Unusual Case of Hematometra in a Postmenopausal Woman Associated With Manchester Repair

Abstract

Hematometra is a rare condition caused by obstruction of the lower female genital tract resulting in an accumulation of menstrual fluid in the uterine cavity. Although most commonly a result of congenital abnormalities, in older women, the obstruction is usually acquired and occurs at the level of the cervix.The Manchester repair procedure, done for uterocervical prolapse as an alternative to vaginal hysterectomy, carries a risk of cervical scarring resulting in stenosis and hematometra. A 61-year-old woman presenting with acute pelvic pain on a background of chronic pelvic pain and urinary retention was found to have a pelvic mass. She underwent magnetic resonance imaging, and her case was discussed in the gynecologic oncology multidisciplinary meeting. She underwent a midline laparotomy and was found to have hematometra. This was a result of the post-Manchester repair amenorrhea being considered as menopause, leading to a gradually accumulating hematometra. Very few Manchester repairs are being carried out these days. Although advocated as a safe alternative to vaginal hysterectomy, clinicians doing this procedure should be aware of long-term complications like cervical stenosis.