Cervical Stump Research Articles

Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when?

PurposeThe rates of hysterectomy are falling worldwide, and the surgical approach is undergoing a major change. To avoid abdominal hysterectomy, a minimally invasive approach has been implemented. Due to the increasing rates of subtotal hysterectomy, we are faced with the following questions: how often does the cervical stump have to be removed secondarily, and what are the indications?MethodsThis was a retrospective, single-centre analysis of secondary resection of the cervical stump conducted from 2004 to 2018.ResultsSecondary resection of the cervical stump was performed in 137 women. Seventy-four percent of the previous subtotal hysterectomy procedures were performed in our hospital, and 26% were performed in an external hospital. During the study period, 5209 subtotal hysterectomy procedures were performed at our hospital. The three main indications for secondary resection of the cervical stump were prolapse (31.4%), spotting (19.0%) and cervical dysplasia (18.2%). Unexpected histological findings (premalignant and malignant) after subtotal hysterectomy resulted in immediate (median time, 1 month) secondary resection of the cervical stump in 11 cases. In four patients, the indication was a secondary malignant gynaecological disease that occurred more than 5 years after subtotal hysterectomy. The median time between subtotal hysterectomy and secondary resection of the cervical stump was 40 months. Secondary resection of the cervical stump was performed vaginally in 75.2% of cases, laparoscopically in 20.4% of cases and abdominally in 4.4% of cases. The overall complication rate was 5%.ConclusionSecondary resection of the cervical stump is a rare surgery with a low complication rate and can be performed via the vaginal or laparoscopic approach in most cases. The most common indications are prolapse, spotting and cervical dysplasia. If a secondary resection of the cervical stump is necessary due to symptoms, 66.6% will be performed within the first 6 years after subtotal hysterectomy.

Sentinel Lymph Node Mapping in Endometrial Cancer after Supracervical Hysterectomy

BackgroundOccult endometrial cancer after supracervical hysterectomy is uncommon. Even if optimal management of those rare cases is still unproven, to guide the need for adjuvant treatment, restaging should be recommended in this situation.MethodsThe study was approved by institutional review board (DIPUSVSP-27-07-20107). We report the case of a 52-year-old woman with occult grade 2 endometrioid endometrial adenocarcinoma (pT1a) with negative surgical margin and smooth uterine muscle of uncertain malignant potential after supracervical hysterectomy and bilateral salpingo-oophorectomy performed for pelvic pain and uterine fibroids in a local hospital. Preoperative CT scan of chest-abdomen-pelvis did not show any lymphadenopathy or distant metastasis. Pelvic US scan revealed a normal cervical stump and a hypoechoic 18-mm right parametrial nodule. We describe the feasibility of laparoscopic sentinel lymph node identification with cervical stump injection of indocyanine green.ResultsThe patient underwent laparoscopic radical trachelectomy, left pelvic sentinel lymph node biopsy, right pelvic lymphadenectomy, peritoneal washing. Patient did not report any intraoperative or postoperative complication. At final histology cervix, SLN (ultrastaging) and pelvic lymph nodes were negative, while parametrial nodule was reported as metastasis from endometrial adenocarcinoma. Surgical margins were clear. Patient was staged as FIGO IIIB and underwent adjuvant chemo-radiation. She is now alive and disease-free, 12 months after the surgery.ConclusionsThis video (Video 1) underlines the fact that SLN mapping with cervical injection is a feasible and safe technique also without the uterine corpus after supracervical hysterectomy. The unilateral mapping could be due to the presence of metastatic parametrium on the right side.

PO-1982 Dosimetric and clinical outcome in image guided interstitial brachytherapy for cervical stump cancer

PO-1982 Dosimetric and clinical outcome in image guided interstitial brachytherapy for cervical stump cancer

Cervical stump necrosis after laparoscopic supracervical hysterectomy: successful management by laparoscopic approach.

Persistent bleeding from the remaining cervix after laparoscopic supracervical hysterectomy (LSH) is normally related to the presence of residual functioning endometrial tissue. However, postoperative significant vaginal hemorrhage caused by cervical necrosis following LSH is relatively rare. A 39-year-old nulligravida was admitted to the emergency department with hypovolemic shock after LSH performed in another hospital for treatment of uterine fibroids 18 days previously. Following hemodynamic stabilization and mechanical tamponade of the bleeding uterine cervix, laparoscopic simple trachelectomy was carried out and antibiotics were administered. The patient developed no surgical or clinical complications and was discharged 4 days after surgery. Histologic examination revealed extensive areas of tissue necrosis and no signs of malignancy. Stump necrosis and accompanying bleeding are rare but serious complications of LSH. Infection is an important component of this entity and should be treated. Endoscopic management of this condition appears to be feasible and safe.

Laparoscopic removal of the cervical stump for a cervical solid mass in a patient with previous supracervical hysterectomy

The aim of this video article is to demonstrate a surgical tutorial in which a cervical mass was resected with laparoscopic removal of the cervical stump after supracervical hysterectomy (SCH). First, the dense adhesions due to previous operation were dissected. Then the dissection was continued carefully in order to identify bilateral ureters and iliac arteries. A cervical mass of nearly 4 cm was identified at the posterosuperior aspect. The mass was separated from surrounding tissue and removal of the cervical stump was performed. This is an exciting case, illustrating that minimally invasive procedures, such as laparoscopic removal of the cervical stump after SCH, can be used in the management of benign cervical tumor. The main feature of this operation was to check the relationship of tumor with adjacent structures, including ureters, bowel and vascular structures at every step to prevent unwanted injuries.

Comprehensive treatment of cervical intraepithelial neoplasia

Aim. To study the effectiveness of the use of Neovir (sodium oxodihydroacridinyl acetates) as immunomodulatory and antiviral drug in the comprehensive treatment of various grade cervical intraepithelial neoplasia (CIN). Study design: prospective comparative study.
 Materials and methods. The study included 60 patients (mean age 34.78.2 years) with morphologically verified various grade CIN, who were received comprehensive treatment, including the use of Neovir (sodium oxodihydroacridinyl acetate) as the drug with immunomodulatory and antiviral activity, 250 mg/2 ml intramuscularly every 48 hours, 10 injections before (group 1) or after (group 2) multi-stage radiosurgical diagnostic and treatment procedure or only a similar surgical intervention (group 3). All patients underwent complete clinical, morphological and laboratory examination with monitoring for the presence of high-risk human papillomavirus (HPV) in the cervical scraping and the dynamics of peripheral blood lymphocyte subpopulations.
 Results. Dynamic follow-up showed that in a month after surgery, patients who were treated with radiosurgical resection as monotherapy (group 3) had the lowest rate of complete epithelialization of the cervical stump 30.0% vs 55.0 and 65,0% in the group 1 and group 2 respectively. In this group, the proportion of patients with persistent viral infection was 1.52 times higher than in the groups where an antiviral drug was used in combination with radiosurgical intervention 35.7% vs 17.6 and 22.2% in the group 1 and group2, respectively. In 6 months, elimination of high-risk HPV in groups with comprehensive treatment reached 94.5 in the group 1 and 94.1% in the group 2 (p0.05) vs 78.6% in the group 3. The lowest number of TNK- and NK-cells was found in the group of patients who received radiosurgical treatment as monotherapy, which correlated with the highest incidence of high-risk HPV persistence after treatment in this group.
 Conclusions. In patients with various grade CIN, the use of an immunomodulatory drug with antiviral activity in combination with radiosurgical intervention promotes early epithelialization of the cervix and elimination of high-risk HPV, which is confirmed by significant changes in the lymphocyte subpopulations which provide antiviral immunity.

The influence on resection line during supracervical hysterectomy: physiological extension of endometrial cells in the cervix uteri

Objective:A straight resection of corpus uteri using the sacrouterine ligament as landmark is a common method during supracervical hysterectomy. Subsequent spotting rates of up to 25% suggest the existence of residual endometrial glands in the remaining cervical tissue, casting doubt on the landmark qualities of the sacrouterine ligament. Fifty-one females who underwent total laparoscopic hysterectomy for benign diseases were investigated.Material and Methods:Macroscopic uterine parameters were determined during operation. First appearance of endometrium cells, complete disappearance of endometrial cells in the cervix and others were measured microscopically with reference to the external cervical orifice. Associations were described using odds ratio with 95% confidence interval and p-value <0.05.Results:The region of the cervix, in which exclusively cervical glands are found, is relatively small but varies considerably around the mean (mean, 23.3 mm, range, 10 to 35 mm). In this cohort in a remnant cervical stump of 23 mm length, endometrial glands would be found in 51%. There was no correlation between full cervical length and uterine parameters but smaller uteri tended to be associated with deeper endometrial penetration.Conclusion:There is a discrepancy between common definition and histological findings concerning the cervix uteri. Our findings indicate that the sacral uterine ligament is not suitable as an anatomic landmark for the laparoscopic supracervical hysterectomy operation. Regarding the distribution pattern of endometrial glands in the isthmic zone, a deep conical excision seems to better prevent subsequent spotting than a straight resection with thermocoagulation of the remaining cervical canal.

Characteristics, complications, and outcomes of early-stage cervical stump carcinoma: laparoscopy versus laparotomy.

ObjectiveTo compare the characteristics, surgical complications, and overall survival between patients undergoing laparoscopy versus laparotomy for treatment of early-stage cervical stump carcinoma.MethodsPatients with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA2 to IIA2 cervical stump carcinoma who underwent laparoscopy or laparotomy in the Obstetrics and Gynecology Hospital of Fudan University from January 2000 to June 2018 were retrospectively reviewed. All patients’ clinical characteristics, pathological features, complications, and follow-up data were retrieved.ResultsSeventy-two patients were included in the analysis; 58 underwent laparoscopy and 14 underwent laparotomy. With respect to surgical complications, laparoscopy was associated with a significantly lower complication rate, less blood loss, a shorter operative time, and a higher hospitalization fee than laparotomy. Survival was not significantly different between the laparoscopy and laparotomy groups.ConclusionsAlthough survival was not significantly different between the two surgical approaches, the rate of surgical complications was much lower in the laparoscopy than laparotomy group.

Large Isolated Benign Metastasizing Leiomyoma of the Lung

A 58-year-old woman was referred with a right chest benign metastasizing leiomyoma. Medical history included a subtotal hysterectomy, bilateral salpingo-oophorectomy, and resection of the cervix for paracervical leiomyoma at the cervical stump. Aside from an intermittent productive cough and decreased exercise tolerance, she was asymptomatic.

Two-stage Reconstruction Using a Free Jejunum/Ileum Flap After Total Esophagectomy.

Reconstruction after esophagectomy is conventionally performed with a gastric conduit. However, in cases where a gastric conduit is unavailable, reconstructive procedures vary in terms of flap type, operative timing, and conduit route. Single-stage surgery is associated with a long operation time and high surgical stress, resulting in perioperative mortality. Recent advances in reconstructive microsurgery have made free intestinal flap transfer safe and reliable. Therefore, to overcome the shortcomings with previous methods, we performed 2-stage surgery involving free jejunum/ileum transfer for reconstruction after esophagectomy. From 2010 to 2018, 42 free jejunum/ileum flaps were transferred for reconstruction after esophagectomy in 41 patients. The diagnosis was esophageal cancer in 38 patients. All operations were performed in 2 stages. In most cases, total esophagectomy was performed in the first operation. The cervical stump of the esophagus was sutured to the cervical skin, creating an esophagostomy in the left neck. About 4 to 7 weeks after the first operation, the second operation was performed. The free jejunum/ileum flap was transferred through the subcutaneous route. Microvascular anastomosis was performed with the internal mammary artery and internal mammary vein, transverse cervical artery, internal and external jugular veins (internal jugular vein and EJV, respectively), and cephalic vein. The mean follow-up duration was 20 months. Free jejunum/ileum transfer was performed as the first operation in 4 cases and as the second operation in 38 cases. A free jejunal flap was used in 36 cases and free ileal flap was used in 6 cases. The recipient arteries were the internal mammary artery in 38 cases and transverse cervical artery in 4 cases. The recipient veins were the internal mammary vein in 15 cases, cephalic vein in 13 cases, EJV in 10 cases, and internal jugular vein in 10 cases. The flaps survived in all cases, except 1 case (41/42, 97.6%). The complications were anastomotic leakage of the flap in 9 cases, respiratory complications in 10 cases, and ileus in 2 cases. Perioperative mortality was not noted. Two-stage surgery using free jejunum/ileum flap transfer is a safe and reliable option for esophageal reconstruction in cases where gastric pull-up is unavailable.

Large pelvic mass arising from the cervical stump: A case report

A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare. After supracervical hysterectomy, there is a risk of various lesions occurring in the cervical stump. We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy. Gynecologists should choose the most suitable surgical method based on both the patient's condition and wishes. If the cervix is retained, patients require a close follow-up. A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass. Her chief complaint was abdominal distention for two months. She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior. Abdominal ultrasonography detected a 9.1 cm × 8.5 cm × 8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53 (HPV53) was positive. The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump. We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion. The pelvic mass was removed, and a bilateral adnexectomy was implemented. Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion. After successful intervention, the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo. When addressing benign uterine diseases, gynecologists should pay adequate attention to retaining the cervix. If the cervix is retained, patients require a close follow-up.

Analysis of the poor prognostic factors affecting 48 cases of cervical stump carcinoma

Objective To explore the poor prognostic factors of patients with cervical stump carcinoma, aiming to provide certain reference for the clinical diagnosis and treatment. Methods Clinical data of 48 patients with cervical stump carcinoma admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from January 1, 2005 to December 1, 2016 were retrospectively analyzed. A total of 19 patients (40%) withⅠA-ⅡA stage cervical stump carcinoma were treated with surgery+ adjuvant therapy and 29 patients (60%) in ⅡB-Ⅳ stage received radiotherapy combined with chemotherapy. The median age of onset was 51 years old. Uterine fibroids were the main cause of subtotal hysterectomy. The average time interval from subtotal hysterectomy to definite diagnosis was 10.76 years. Results The 1-, 3-, 5-year survival rate was 98%, 83% and 74%, respectively. Univariate analysis demonstrated the time interval from subtotal hysterectomy (P=0.016), tumor diameter (P=0.016), clinical stage (P=0.036), histological grade (P=0.009), lymph node metastasis (P=0.044), parametrial invasion (P=0.046), myelosuppression (P=0.013) and radical surgery (P=0.019) were the poor prognostic factors of cervical stump carcinoma. Conclusions Poor prognosis of patients with cervical stump carcinoma is correlated with tumor diameter, clinical stage, histological grade, lymph node metastasis, parametrial invasion and myelosuppression. Histological grade is an independent risk factor. Key words: Cervical stump; Malignant neoplasm/radiochemotherapy; Prognosis

2870 Tips and Tricks in Laparoscopic Removal of the Remaining Cervical Stump

Study Objective the objective is to propose specific recommendations regarding the laparoscopic approach for removal of the retained cervix after subtotal hysterectomy. This is a rare operation and it will require systematic preoperative assessment and intraoperative approach. Design Retrospective study of 10 cases done over three years with follow up. Setting All cases were done in one centre and all had a laparoscopic approach with variable difficulty intraoperatively. Patients or Participants The cases had retained the cervix for different reasons; including a default approach to leave the cervix, surgical difficulty due to endometriosis. the reason for removing the remaining cervix included cervical abnormality, symptoms of pain, bleeding and Interventions the cases had standard laparoscopic approach. Measurements and Main Results all cases were successful in achieving the target of the removal of the cervical stump. One case needed conversion to laparotomy due to severe adhesions and bowel injury. one cases resulted in some worsening prolapse and two cases still have residual pain. Conclusion These cases need a careful preoperative assessment including a thorough analysis of the reason of leaving the cervix. The assessment should include transvaginal ultrasound to assess the length of the cervix and the Pouch of Douglas and supported by Pelvic MRI. Colposcopy and hysteroscopy can be useful aids to assess high grade lesions and evaluate endocervical canal to exclude precancer or cancer. It is a useful recommendation to avoid instrumentation of the cervix. McCartney tube can be considered instrument of choice for manipulation and colpotomy. Bilateral ureterolysis is strong recommendation and prior ureteric stenting can be useful in anticipation of residual severe endometriosis. Ample dedicated surgical time is important as the degree of adhesions over the remaining stump is unpredictable. These cases should attempted at advanced laparoscopic settings.

2032 Laparoscopic Pectopexy for Prolapse Repair

Video Objective To study the efficacy and safety of Laparoscopic Pectopexy Setting Tertiary care center Interventions Since October 2015 till March 2019 – 50 cases of pectopexy have been done. Most of the cases have been of Hysteropexy in age group of 27-36 years (mean age 32 years) and 7 cases of Laparoscopic Subtotal Hysterectomy in age group of 42- 67 years (average age 54.5). And 4 cases of vault prolapse. Our technique combines site specific repair with mesh augmented repair. Anterior pelvic support is pubocervical fascia which is dissected after pushing the bladder down, and plicated with 1-0 polyester suture. After plication of Pubocervical fascia a 15 cm by 3 cm size mesh is applied over the cervical stump / lower uterine segment / vaginal vault in the center. The lateral attachments of the mesh are fixed over to the iliopectineal ligament on both the sides. Iliopectineal ligament is the posterior prolongation of the Cooper's ligament. For a global repair and long term good results plication of the uterosacral ligaments is done. Conclusion Pectopexy appears to be a new, useful tool in the armamentarium of gynecological endoscopists for hysteropexy in patients desirous of further child bearing as it gives bilateral support at level of pericervical ring. It is also applicable for vault prolapse repair and after Laparoscopic Subtotal Hysterectomy for vault suspension.

A computational study of organ relocation after laparoscopic pectopexy to repair posthysterectomy vaginal vault prolapse

ABSTRACTMinimally invasive surgery such as laparoscopic sacrocolpopexy, pectopexy and cervicosacropexy are widely performed for the treatment of the vaginal vault/cuff prolapse using prosthetic mesh implants to strengthen lax apical ligaments. Depending on the patient’s anatomy and the surgeon’s preference, implants of different shapes, pore architectures and polymers can be selected. In this article, a 3D model of the pelvis was built and the pectopexy technique was reproduced. The finite element model of the textile implant was sutured to the cervical stump with a bilateral fixation to the iliopectineal ligament on either side of the pelvic walls. Pelvic soft tissues and prosthetic implants were modelled as hyperelastic and linearly elastic orthotropic materials, respectively. Numerical simulations were performed after surgery at rest and during Valsalva manoeuvre. The positions and the orientation of the vagina, during increased abdominal pressure were calculated in relation to the pubococcygeal line (PCL). We found from our simulation-model that the structure of the DynaMesh®-PRP Soft (17.18 mm above PCL line) provides better support to the vaginal cuff compared to GYNEMESH (11.95 mm) and ARTISYN (6.72 mm). And the treatment with, the stiffer DynaMesh seems to provide better urethral axis (24°) than the flexible Ethicon meshes (28.5° and 29°).

Stump Pyometra Secondary to Human Topical Estrogen Hormone Exposure in a Spayed Female Chihuahua.

A 6 yr old female spayed Chihuahua was presented for evaluation of intermittent vulvar discharge, stranguria, and vomiting. This dog had an ovariohysterectomy as a puppy and did not experience any evidence of estrous until 4.5 yr later. The owner had been using a topical hormone replacement therapy (estradiol spray) twice daily for the duration of the dog's clinical signs of 1 yr. On presentation, the dog had truncal alopecia, comedones, enlarged vulva with a malodorous, and purulent discharge. Bloodwork showed a leukocytosis with a neutrophilia, döhle bodies, and moderate toxic changes. An abdominal ultrasound revealed an enlarged uterine stump with a thickened wall, ovoid projection cranially, and echogenic luminal contents. An exploratory laparotomy identified an enlarged cervical stump. Histopathology revealed chronic suppurative vaginitis with endometritis, necrosis, and intraluminal coccoid bacteria. The dog recovered well from surgery. A baseline estrogen level post operatively was measured at 56.4 pg/mL (<50.0 pg/mL for a spayed bitch), at this time, the dog had been separated from the owner for 7 days. After surgery, the clinical signs disappeared, and the dog's dermatologic changes improved. This is the first reported case of stump pyometra following exposure to the owner's topical estradiol replacement medication.

Cervical stump pregnancy 6 years after subtotal hysterectomy: a case report

BackgroundPregnancy following hysterectomy is very rare and may lead to significant morbidity, especially when diagnosis is delayed.Case presentationA 32-year-old G3P3002 African woman presented with increasing abdominal distension and 1 day of worsening abdominal pain and vomiting. Her previous pregnancy had ended 6 years prior with a stillborn baby delivered by Cesarean hysterectomy after laboring at home for 1 day. At the time of current presentation, this patient was confused and irritable, with an undetectable blood pressure, tachycardia, labored breathing, and a distended and tender abdomen. Urine human chorionic gonadotropin was positive and a transabdominal ultrasound showed significant intraperitoneal fluid collections and a singleton, viable pregnancy consistent with 13 weeks of gestation. A diagnosis of hypovolemic shock secondary to ruptured ectopic pregnancy was made, and she underwent emergency laparotomy. Intraoperative findings included 4.5 liters of hemoperitoneum and a cervical stump pregnancy with active bleeding from a partially detached placental site.ConclusionAny reproductive-aged woman with at least one ovary and a means for sperm to meet egg should be screened for pregnancy if she presents with an acute abdomen or abdominal or pelvic pain.

98: Do attending physicians and trainees agree about what happens in the operating room during robot-assisted laparoscopic hysterectomy procedures?

The objective in this study was to determine agreement between attending and trainee surgeons on important aspects of what happened in the operating room during robot-assisted laparoscopic hysterectomy (RALH) procedures, which are essential for teaching and assessment, e.g., case participation for accurate case logs, intraoperative skill assessment for performance evaluation and feedback. Attending and trainee surgeons performing 56 RALH procedures responded to questionnaires postoperatively concerning: 1) who performed each of 11 steps (L/R excise infundibulopelvic ligament, excise utero-ovarian ligament, skeletonize uterine vessel, electrodessicate uterine vessels, dissect bladder, colpotomy or amputate uterus, close vaginal cuff or cervical stump), 2) vaginal cuff closure technique (VCCT) and suture device (SD) used, 3) trainees’ self-assessed skill and attending assessment of trainees’ skill using GEARS, and difficulty of surgery. For bladder dissection, colpotomy, and vaginal cuff closure, we asked what percentage (0%, 25%, 50%, 75%, or 100%) was performed by the trainee. We analyzed agreement between attending and trainee surgeons using Cohen’s kappa for categorical variables and Krippendorff’s alpha (KA) for ordinal variables, as well as Spearman’s correlation (rho). Kappa was greater than 0.6 for 8 surgical steps (kappa = 0.71, 0.62, 0.82, 0.85, 0.71, 0.78, 0.86, 0.86), suggesting strong agreement between attending and trainee surgeons. We observed kappa values of 0.79 and 0.79 for VCCT and SD, indicating strong agreement. There was weak agreement for depth perception and bimanual dexterity criteria of the GEARS scale (rho = 0.21, 0.29 and KA = 0.158, 0.007, respectively). Skill assessments by attending and trainee surgeons on the domains of efficiency, force sensitivity, autonomy, and robotic control exhibited moderate correlation and agreement (rho = 0.468, 0.534, 0.440, 0.495; KA = 0.473, 0.506, 0.412, 0.484, respectively). There was a moderate level of agreement (kappa = 0.484) on estimating difficulty of surgical case. Our findings show that there is imperfect agreement between attending and trainee surgeons even with who performed parts of the procedure, which intuitively, should be unambiguous. They also disagreed on case difficulty and technical skill. This incongruency on critical aspects of what happened in the operating room poses a significant challenge to teach and learn hysterectomy.

Cervical Stump Fibroidpost Supra-cervical Hysterectomy

Objective: To describe of a rare case of cervical stump fibroid presenting as a late complication of supra-cervical hysterectomy. Methods: A 68-year old-female with a history of lower abdominal pain and distention for six months with increasing intensity was referred from a local clinic to the department of radio-diagnosis for evaluation. She had a history of subtotal hysterectomy previously. On ultrasonography and computerized tomography imaging studies, a large adnexal lesion was noted suggesting the possibility of a cervical stump leiomyoma. The patient underwent an elective surgery and the diagnosis was confirmed in the context of histological findings. Results: Patient was operated for the radiologically diagnosed large cervical stump leiomyoma which was laterhistologically confirmed with an uneventful recovery. Conclusions: Imaging investigations like computerized tomography and magnetic resonance imaging are valuable in the diagnosis of rare adnexal masses from cervical stump arising as late delayed complications of supra-cervical hysterectomy. Keywords: Cervical stump leiomyoma, computerized tomography, magnetic resonance imaging, supra-cervical hysterectomy DOI: 10.15850/ijihs.v6n2.1257

Cervical Stump Fibroidpost Supra-cervical Hysterectomy

Objective: To describe of a rare case of cervical stump fibroid presenting as a late complication of supra-cervical hysterectomy. Methods: A 68-year old-female with a history of lower abdominal pain and distention for six months with increasing intensity was referred from a local clinic to the department of radio-diagnosis for evaluation. She had a history of subtotal hysterectomy previously. On ultrasonography and computerized tomography imaging studies, a large adnexal lesion was noted suggesting the possibility of a cervical stump leiomyoma. The patient underwent an elective surgery and the diagnosis was confirmed in the context of histological findings. Results: Patient was operated for the radiologically diagnosed large cervical stump leiomyoma which was laterhistologically confirmed with an uneventful recovery. Conclusions: Imaging investigations like computerized tomography and magnetic resonance imaging are valuable in the diagnosis of rare adnexal masses from cervical stump arising as late delayed complications of supra-cervical hysterectomy. Keywords: Cervical stump leiomyoma, computerized tomography, magnetic resonance imaging, supra-cervical hysterectomy DOI: 10.15850/ijihs.v6n2.1257