Sohail Mahmood Chaudhry, Shahnaz Anwer.
Presentation and Management of Vaginal Vault Hematoma after Hysterectomy.
J Surg Pak Jan ;21(1):35-8.

Objective: To detect and manage vaginal vault hematoma following abdominal and vaginal hysterectomy. Study design: Descriptive case series. Place & Duration of study: Department of Obstetrics & Gynaecology Unit-1, Bahawal Victoria Hospital/Quaid-e-Azam Medical College Bahawalpur, From January 2009 to December 2013. Methodology: During the period 921 women underwent hysterectomy, 276 through vaginal and 645 through abdominal approach. Patients were scanned on Ist and 3rd postoperative day. A transabdominal scan was done in patients who underwent vaginal hysterectomy and a transvaginal scan was done for those who had undergone abdominal hysterectomy. The findings were used to relate the postoperative morbidity in cases of vault hematoma. Results: Of the total 921 hysterectomies during the study period overall frequency of vault hematoma was 5.32% (n=49). It was 2.89% (n=8/276) in with vaginal hysterectomy and 6.35% (n=41/645) in abdominal hysterectomy. The most common presenting symptom in postoperative period was unexplained fever (n=23/82 - 28%) in abdominal hysterectomies. In vaginal hysterectomies most of the patients were diagnosed by presence of collection on rescan (n=8/21 - 38%). Majority of patients in vaginal hysterectomy group were managed conservatively and only 25% underwent colpotomy. In abdominal hysterectomies hematomas were mostly (78%) drained by colpotomy. Conclusion: Ultrasonography to detect postoperative hematomas on 3rd postoperative day following hysterectomy identified high risk group of patients who need further management or follow up before discharge.

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