PDF(Pubmed)
Abstract：
Uterine diverticulum is classified into congenital and acquired types. The acquired type is caused by caesarean scar syndrome, which occurs after caesarean section. There are no detailed reports on diverticulum after enucleation of uterine fibroids. Most cases are treated with hysteroscopy or laparoscopy, but a management consensus is lacking. We treated a patient with a uterine diverticulum that had formed after uterine fibroid enucleation by combining hysteroscopic and laparoscopic treatments.
The patient was a 37-year-old Japanese woman, G1P0. A previous doctor had performed abdominal uterine myomectomy for a pedunculated subserosal uterine fibroid on the right side of the posterior wall of the uterus near the internal cervical os. Menstruation resumed postoperatively, but a small amount of dark-red bleeding persisted. MRI two months after the myomectomy revealed a diverticulum-like structure 3 cm in diameter, communicating with the uterine lumen, on the right side of the posterior wall of the uterus. Under suspicion of uterine diverticulum after uterine fibroid enucleation, the patient sought treatment at our hospital approximately four months after the myomectomy. Through a flexible hysteroscope, a 5-mm-diameter fistula was observed in the posterior wall of the uterus, and a contrast-enhanced pocket, measuring approximately 3 cm, was located behind it. Uterine diverticulum following enucleation of a uterine fibroid was diagnosed, and surgery was thus deemed necessary. The portion entering the fistula on the internal cervical os side was resected employing a hysteroscope. Intra-abdominal findings included a 4-cm mass lesion on the posterior wall on the right side of the uterus. The mass was opened, and the cyst capsule was removed. A 5-mm fistula was detected and closed with sutures. Resuturing was not performed after dissection of the right round ligament due to tension. The postoperative course has been good to date, with no recurrence.
Uterine diverticula after myomectomy may be treated with a combined laparoscopic and hysteroscopic approach, similar to caesarean scar syndrome.
The patient was a 37-year-old Japanese woman, G1P0. A previous doctor had performed abdominal uterine myomectomy for a pedunculated subserosal uterine fibroid on the right side of the posterior wall of the uterus near the internal cervical os. Menstruation resumed postoperatively, but a small amount of dark-red bleeding persisted. MRI two months after the myomectomy revealed a diverticulum-like structure 3 cm in diameter, communicating with the uterine lumen, on the right side of the posterior wall of the uterus. Under suspicion of uterine diverticulum after uterine fibroid enucleation, the patient sought treatment at our hospital approximately four months after the myomectomy. Through a flexible hysteroscope, a 5-mm-diameter fistula was observed in the posterior wall of the uterus, and a contrast-enhanced pocket, measuring approximately 3 cm, was located behind it. Uterine diverticulum following enucleation of a uterine fibroid was diagnosed, and surgery was thus deemed necessary. The portion entering the fistula on the internal cervical os side was resected employing a hysteroscope. Intra-abdominal findings included a 4-cm mass lesion on the posterior wall on the right side of the uterus. The mass was opened, and the cyst capsule was removed. A 5-mm fistula was detected and closed with sutures. Resuturing was not performed after dissection of the right round ligament due to tension. The postoperative course has been good to date, with no recurrence.
Uterine diverticula after myomectomy may be treated with a combined laparoscopic and hysteroscopic approach, similar to caesarean scar syndrome.
摘要：
背景：子宫憩室分为先天性和获得性。获得性类型是由剖腹产疤痕综合征引起的，发生在剖腹产后。没有关于子宫肌瘤摘除术后憩室的详细报道。大多数病例接受宫腔镜或腹腔镜检查，但是缺乏管理共识。我们通过结合宫腔镜和腹腔镜治疗，对子宫肌瘤摘除后形成的子宫憩室患者进行了治疗。
方法：患者是一名37岁的日本女性，G1P0。以前的医生曾在子宫颈内口附近的子宫后壁右侧进行过子宫子宫肌瘤切除术。术后月经恢复，但仍有少量暗红色出血.子宫肌瘤切除术后两个月的MRI显示直径3厘米的憩室样结构，与子宫腔相通，在子宫后壁的右侧。怀疑子宫肌瘤摘除术后子宫憩室，患者在子宫肌瘤切除术后约4个月在我们医院寻求治疗.通过灵活的宫腔镜，在子宫后壁观察到直径为5毫米的瘘管，和一个对比增强的口袋，大约3厘米，位于它后面。诊断为子宫肌瘤摘除后子宫憩室，因此，手术被认为是必要的。使用宫腔镜切除进入子宫颈口内侧瘘管的部分。腹内发现包括子宫右侧后壁4厘米的肿块病变。弥撒被打开了，囊肿囊被切除了.检测到5毫米的瘘管并用缝线闭合。由于张力，右圆韧带解剖后未进行恢复。迄今为止，术后进展良好，没有复发。
结论：子宫肌瘤切除术后子宫憩室可采用腹腔镜联合宫腔镜治疗，类似于剖腹产疤痕综合症。
方法：患者是一名37岁的日本女性，G1P0。以前的医生曾在子宫颈内口附近的子宫后壁右侧进行过子宫子宫肌瘤切除术。术后月经恢复，但仍有少量暗红色出血.子宫肌瘤切除术后两个月的MRI显示直径3厘米的憩室样结构，与子宫腔相通，在子宫后壁的右侧。怀疑子宫肌瘤摘除术后子宫憩室，患者在子宫肌瘤切除术后约4个月在我们医院寻求治疗.通过灵活的宫腔镜，在子宫后壁观察到直径为5毫米的瘘管，和一个对比增强的口袋，大约3厘米，位于它后面。诊断为子宫肌瘤摘除后子宫憩室，因此，手术被认为是必要的。使用宫腔镜切除进入子宫颈口内侧瘘管的部分。腹内发现包括子宫右侧后壁4厘米的肿块病变。弥撒被打开了，囊肿囊被切除了.检测到5毫米的瘘管并用缝线闭合。由于张力，右圆韧带解剖后未进行恢复。迄今为止，术后进展良好，没有复发。
结论：子宫肌瘤切除术后子宫憩室可采用腹腔镜联合宫腔镜治疗，类似于剖腹产疤痕综合症。
