Vaginal cuff endometriosis after laparoscopic-assisted vaginal hysterectomy: a case report and literature review

Background: Endometriosis of the vaginal cuff after hysterectomy is extremely rare. Here we present a case of endometriosis at the vaginal cuff after laparoscopic-assisted vaginal hysterectomy (LAVH). Case: A 41-year-old woman was admitted complaining of sudden massive vaginal bleeding. The patient had a history of hysterectomy 3 years prior due to symptomatic multiple leiomyomas and adenomyosis. A lesion was found at her vaginal cuff, which infiltrated the serous membrane of the rectum and spontaneously ruptured her vagina. However, she had no previous history of endometriosis. The patient was treated with local lesion excision via laparotomy. The pathological diagnosis of the excised tissue was endometriosis. A gonadotropin-releasing hormone (GnRH) agonist was administered three times postoperatively. The patient recovered well without evidence of disease 4 months after the excision. Conclusion: Any lesion that evolves in response to the menstrual cycle should be considered as endometriosis.