Treatment of dysfunctional uterine bleeding

BMJ 1995;310:801-802 (25 March)

Letters

Treatment of dysfunctional uterine bleeding

Serious complications may occur after hysteroscopic procedures

EDITOR,--The low incidence of major postoperative complicationsafter hysteroscopic procedures for dysfunctional uterine bleedingin S B Pinion and colleagues' study¹ certainly seems to suggestthat there is a future for such procedures. Serious complicationscan, however, arise, as we recently witnessed.

An obese 44 year old woman underwent hysteroscopic diathermyablation of the endometrium for menorrhagia. Her medical historyincluded a right ovarian cystectomy, appendicectomy, and cholecystectomy.She did not have any concurrent gastrointestinal complaints.Four days postoperatively she developed a faecal vaginal discharge.A barium study and examination under anaesthesia showed thepresence of a colouterine fistula. She underwent a laparotomy,at which, after extensive division of ahesions she was foundto have moderate diverticular disease of the sigmoid colon witha loop stuck to the left posterolateral aspect of the uterusforming the fistulous communication. Given the degree of adhesions. . . [Full text of this article]