De Novo Endometrial Implant Into the Colon After Uterine Morcellation
Erin M. Mellano, MD, Christy M. Anthony, BS, Tamara Grisales, MD, Christopher M. Tarnay, MD
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA (all authors).
Instances of iatrogenic endometriosis after laparoscopic supracervical hysterectomy are uncommon but have been reported in the literature in women undergoing hysterectomy for pelvic pain. A 41-year-old woman with no history of endometriosis developed cyclic pain and a mass in her lower abdominal wall after uterine morcellation for a laparoscopic supracervical hysterectomy and sacrocolpopexy for uterocervical prolapse. Exploratory surgery revealed an endometrial implant involving the peritoneum and omentum, with transmural involvement of the cecum at a site separate from the trocar site. Aberrant endometrial cell implantation after morcellation of the uterine corpus has been reported; however, this was a rare instance of transmural large bowel iatrogenic endometriosis, necessitating a partial bowel resection, in a patient without a history of endometriosis or pelvic pain, at a site remote from where the uterus was morcellated and removed. In light of recent concerns over dissemination of occult cancerous cells, this case illustrates that dissemination of noncancerous cells can similarly have detrimental outcomes for patients.
Key Words: Endometriosis, Laparoscopy, Supracervical hysterectomy, Uterine morcellation.