|Year : 2015 | Volume
| Issue : 6 | Page : 779-780
Cases of fallopian tube prolapse
Sushil Chawla1, Binod Bishnu Rout2
1 Department of Obstetrics and Gynaecology, INHS Sanjivani, Cochin, Kerala, India
2 Medical Officer, INHS Sanjivani, Cochin, Kerala, India
|Date of Web Publication||19-Nov-2015|
Department of Obstetrics and Gynaecology, INHS Sanjivani, Cochin - 682 004, Kerala
Source of Support: None, Conflict of Interest: None
Fallopian tube prolapse post hysterectomy is rarely reported complication which can lead to doubts in the mind of young and experienced surgeons alike. This leads to patient morbidity and gets different medical treatments ranging from antibiotics to local applications of copper sulphate, without relief. The use of proper surgical technique, prevention of post operative hematoma and infection go a long way in its prevention.We hereby present two cases, which were manged successfully to relieve the patients of their agony.
Keywords: Fallopian tube prolapse, discharge per vaginum, postoperative complications
|How to cite this article:|
Chawla S, Rout BB. Cases of fallopian tube prolapse. Med J DY Patil Univ 2015;8:779-80
| Introduction|| |
Posthysterectomy fallopian tube prolapse (FTP), was first reported by Pozzi in 1902.  The (FTP) after hysterectomy into the vaginal vault is a rare occurrence-approximately 0.01-0.05% of all the hysterectomies. FTP can occur after either total abdominal, vaginal or laparoscopic hysterectomy.  The condition is so under-reported that approximately about 100 cases have been reported in the literature.
| Case Reports|| |
A 42-year-old para3 female who had undergone nondescent vaginal hysterectomy 2 years back presented with symptoms of copious and often blood stained discharge per vaginum. This was associated with postcoital bleeding and lower abdominal pain. She had developed these symptoms 5 months after the surgery and had been treated with multiple courses of antibiotics. The copper sulfate application had been done 1-year back, with no relief to her symptoms. The history revealed she had developed fever after the surgery and had a long hospital stay lasting 15 days with a prolonged course of antibiotics, in the postoperative period. Per speculum examination revealed a polypoidal, strawberry colored growth 1.5 cm × 1.5 cm, at the vaginal vault [Figure 1]. It was not bleeding on touch. The pull on the growth led to severe discomfort to the lady indicating its intra-abdominal origin. The growth was excised by the vaginal route after careful mobilization and reconstructing the vault. Histopathology revealed ciliated columnar lining polypoidal projections and papillae resembling tubal plicae, lamina propria showed chronic inflammatory cells along with few smooth muscle bundles clinching the diagnosis of prolapsed fallopian tube [Figure 2].
|Figure 1: 1.5 cm × 1.5 cm of polypoidal growth — prolapse of fallopian tube|
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|Figure 2: (a and b) HPE of fallopian tube showing chronic inflammatory infi ltrate (H and E, ×40)|
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A 39-year-old woman para3 who had undergone total abdominal hysterectomy 6 months ago for fibroid uterus came with complains of blood stained discharge per vaginum and dyspareunia for last 3 months. She gave no history of fever in the postoperative period. Pelvic examination revealed a red polypoidal mass at the vaginal apex. The growth was excised by the vaginal route. Microscopic examination of a biopsy specimen from the mass revealed the prolapsed fimbrial end of the fallopian tube (no pictures available).
| Discussion|| |
Fallopian tube prolapse can occur anytime after hysterectomy, and the condition has been reported as late as 32 years after the primary surgery. There is insufficient awareness of the possibility of this complication, and most cases are misdiagnosed as granulation, leading to delayed diagnosis and treatment. The causation of FTP is multi-factorial and various factors such as vault hematoma, postoperative fever or infection, poor physical state of the patient, nonclosure of vaginal vault and early resumption of sexual activity predispose the lady to FTP. All the above-mentioned factors lead to poor healing and predispose the lady for disruption of the vaginal vault during the postoperative period. This leads to increased chances of fallopian tube and the prolapsed of other intra-abdominal contents. ,
When symptomatic, patients reported profuse vaginal discharge, ranging from clear and watery, mimicking leakage of urine, to bloody; some patients presented with contact bleeding or dyspareunia, and others complained of lower abdominal or pelvic pain and the most common clinical finding was red vaginal growth. Biopsy of the excised tissue and histopathology examination clinches the diagnosis and immunohistochemistry may serve as tool in doubtful cases, when the typical fallopian tube epithelium is not visualized and IHC for pankreatin antibodies is to be used. ,,,,
No ideal method has been reported for the surgical repair. The literature has reported the recurrence of symptoms and requirement of second and even third surgery to relieve the patient of its symptoms.  We report these two cases as both were repaired by the vaginal route successfully and neither had the recurrence of the symptoms after 6 months of follow-up.
Systematic salpingectomies during conservative hysterectomies may be an appropriate approach to preventing FTP. However, studies will be required to evaluate the effect on ovarian function following this surgery.
| Conclusion|| |
Fallopian tube prolapse is a rare, but increasingly recognized postoperative complication of hysterectomy. The patient satisfaction levels can be significantly improved by increasing awareness of the condition, thereby avoiding delays in diagnosis and treatment.
| References|| |
Pozzi M. Hernia aspirator da the vagina at a scar. C R Soc Obstet Gynaecol Paediatr Paris 1902;4:255-7.
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Fallopian tube prolapse following hysterectomy. Chin Med Sci J 2006;21:20-3.
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Quezada Y, Karram M, Whiteside JL. Case report: Diagnosis and management of peritoneovaginal fistula. J Minim Invasive Gynecol 2015;22:134-6.
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[Figure 1], [Figure 2]