Vaginal vault haematoma following hysterectomy at a tertiary hospital

Eliya-Masamba, Martha (2016-12)

Thesis (MMed)--Stellenbosch University, 2016.

Thesis

Background Hysterectomy 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. Methods This 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. Results Fifty 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. Conclusions Vault 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.

Agtergrond Histerektomie is die tweede mees algemeenste chirurgiese prosedure wat uitgevoer word op vroue in die reproduktiewe ouderdomsgroep, na keisersnit. Koepelhematoom is ‘n erkende komplikasie van histerektomie wat geassosieer word met post-operatiewe morbiditeit. Ultraklank ondersoek van die koepel is waardevol in die diagnose van post-histerektomie koepelhematoom as ‘n oorsaak van koors. Hierdie studie is gedoen om die voorkoms en kliniese belang van post histerektomie koepelhematome in ‘n Suid-Afrikaanse akademiese hospitaal te bepaal. Metodes Dit is ‘n prospektiewe, beskrywende studie. Vroue, 18 jaar en ouer, wat bespreek was vir elektiewe histerektomie vir benigne indikasies, het deelgeneem aan die studie nadat skriftelike toestemming verleen is. Transvaginale ultraklank ondersoek is gedoen 48-72 ure postoperatief en kliniese notas tot 3 maande postoperatief is bestudeer. Resultate Vyftig pasiënte is bestudeer. Voorkoms van koepelhematoom in hierdie kohort was 30% (95% VI 18-44%). Die meerderheid van koepel hematome se grootste omtrek was 2-4cm (67%) gevolg deur sommige meer as 5cm (27%) en ‘n paar minder as 2cm (6%). Daar was geen statistiese verskil in die voorkoms van koepel hematoom tussen die verskillende histerektomie opsies nie (Fisher eksakte toets 0.124). Daar was geen assosiasie tussen die teenwoordigheid van koepel hematoom en post-operatiewe morbiditeit (koors, hemoglobienvlak, verlengde hospitaal verblyf, komplikasies by opvolg). Geen van die pasiënte met koepel hematoom was simptomaties tot en met ontslag van die hospitaal nie. Een pasiënt met ‘n koepel hematoom van meer as 5cm is heropgeneem op dag 15 postoperatief met ‘n slegruikende afskeiding wat suksesvol behandel is met orale antibiotika. Stellenbosch University https://scholar.sun.ac.za Page 9 of 35 Gevolgtrekkings Koepel hematoom kom algemeen voor na elektiewe histerektomie vir benigne ginekologiese indikasies. Pasiënte met koepel hematome is meestal asimptomaties. Daar is geen assosiasie tussen die voorkoms van koepel hematoom en post-operatiewe morbiditeit nie.

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