title: Vaginal cuff endometriosis resulting in a fistula between the vagina and abdominal cavity and presenting as peritonitis: a case report.
abstract: BACKGROUND
  The specimen from a vaginal cuff fistula between the vagina and abdominal cavity revealed endometriosis. Culture of the fluid revealed Streptococcus viridans.
  
  
  METHODS
  A 44-year-old woman presented with lower abdominal pain for 1 week. She also had cyclic vaginal spotting that had started 1 month after she underwent laparoscopically assisted vaginal hysterectomy for a myoma 2 years earlier. One year prior to this admission, she was noted to have a right endometrioma on a sonographic examination; monthly follow-up revealed that the cyst was enlarging. The patient was admitted for surgery. On laparotomy, severe adhesions were noted. After adhesiolysis, a right adnexal cyst with chocolatelike contents mixed with malodorous, yellowish, mucoid fluid was noted. A vaginal cuff fistula between the vagina and abdominal cavity was also noted. The specimen from this area revealed endometriosis. Culture of the fluid showed Streptococcus viridans.
  
  
  CONCLUSIONS
  Various laparoscopic complications are cited in the literature. Although rare, the risk of infection after laparoscopy can occur. In our case the infection may have been caused by the presence of vaginal cuff fistula in the presence of endometriosis.
authors.affiliation: Department of Obstetrics and Gynecology, Shin-Kong Wu Ho Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei, Taiwan.
authors.forename: Kian-Mei
authors.initials: KM
authors.lastname: Chong
authors.forename: Jesse
authors.initials: J
authors.lastname: Chuang
authors.forename: Yieh-Loong
authors.initials: YL
authors.lastname: Tsai
authors.forename: Jiann-Loung
authors.initials: JL
authors.lastname: Hwang
authors.forename: Chun-Cheng
authors.initials: CC
authors.lastname: Chu
mesh_terms: D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000209:etiology; D014594:Uterine Neoplasms / Q000601:surgery; D014624:Vaginal Fistula / Q000175:diagnosis* / Q000209:etiology; D034363:Viridans Streptococci / Q000302:isolation & purification