title: Laparoscopic re-anastomosis of a uterine avulsion following cold-knife conization.
abstract: This report presents an exceptional case of uterine avulsion following a cold-knife conization, an unprecedented surgical complication of a common gynecological procedure. Furthermore, it describes the outcomes of the conservative laparoscopic reconstruction that was performed. A 30-year-old nulliparous was referred to our department with secondary amenorrhea and cyclic pelvic pain following a cold-knife conization performed 9 months previous in another institution. The patient underwent a diagnostic laparoscopy, which confirmed that the cervix had been completely resected and that the uterine and vaginal cavities were no longer in contact. We performed an end-to-end utero-vaginal anastomosis followed by a prophylactic cerclage. No intraoperative or postoperative complications were observed. One month after surgery the patient was asymptomatic with normal withdrawal bleeding and remained asymptomatic during her 12-month follow-up consult. To our knowledge, this is the first time that this serious complication with a potential for irreversible damage to reproductive function is reported as a complication of cervical conization. Although our conservative surgical correction repaired the anatomy and reestablished menstruation outflow, further follow-up is necessary to confirm the extent to which reproductive function was restored.
authors.affiliation: Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal.
authors.forename: Samuel
authors.initials: S
authors.lastname: Santos-Ribeiro
authors.affiliation: Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Coelho
authors.affiliation: Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal.
authors.forename: Teresa Diniz
authors.initials: TD
authors.lastname: da Costa
authors.affiliation: Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Barata
authors.affiliation: Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal.
authors.forename: Conceição
authors.initials: C
authors.lastname: Alho
authors.affiliation: Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Osório
authors.affiliation: Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Calhaz-Jorge
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019092:Conization / Q000009:adverse effects*; D005260:Female; D006409:Hematometra / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery