Vaginal vault haematoma following hysterectomy at a tertiary hospital

[摘要] BackgroundHysterectomy is the second most commonly performed surgical procedure among women of the reproductive age group, after caesarean section. Vault haematoma is a recognized complication of hysterectomy that may be associated with postoperative morbidity. Ultrasound examination of the vault is useful in the diagnosis of post hysterectomy vault haematoma as a cause for febrile morbidity. This study was conducted to determine the incidence and clinical significance of post hysterectomy vault hematomas in a South African Academic setting.MethodsThis was a prospective descriptive observational study. Women aged 18 and above, scheduled for elective hysterectomy for benign indications were enrolled in the study after providing written informed consent. Transvaginal ultrasound scan was done at 48-72 hours post-operative and clinical notes were reviewed 3 months postoperatively.ResultsFifty patients were included in the study. Incidence of vault haematoma in this cohort was 30% (95% CI 18-44%). The majority of vault haematomas was 2-5cm in largest diameter (67%) followed by those that were more than 5cm (27%) and those less than 2cm (6%). There was no statistically significant difference in the incidence of vault haematoma between the different routes of hysterectomy (Fisher's exact 0.124)There was no association between the presence of a vault haematoma and postoperative morbidity (fever, haemoglobin level, prolonged hospital stay, complications at follow up). None of the patients with vault haematoma was symptomatic up to the time of discharge from the hospital. One patient with a vault haematoma more than 5cm was readmitted on Day 15 postoperative with a foul smelling vaginal discharge that was treated successfully with oral antibiotics.ConclusionsVault haematoma is a common finding following elective hysterectomy for benign gynaecological indications. Patients with vault haematomas are mostly asymptomatic. There is no association between the presence of a vault haematoma and postoperative morbidity.

[发布机构] Stellenbosch University