腹式広汎子宮頸部摘出術後に左卵管腟内脱出を認め腹腔鏡下左卵管切除術を施行した一例

抄録

Introduction: Radical trachelectomy is preferred to radical hysterectomy in cases where the patient wants to preserve fertility. This is the first case report of fallopian tube prolapse after abdominal radical trachelectomy.

Case presentation: A 34-year-old woman underwent cervical conization for carcinoma in situ, in which minimally invasive carcinoma was suspected. The pathological findings revealed a squamous cell carcinoma (stageIB1). Abdominal radical trachelectomy was performed to preserve her fertility. Six months after the trachelectomy, speculum examination revealed a papillary tumor with a diameter of 1.5 cm at the vaginal vault. Tumor biopsy showed no evidence of malignancy. Lower abdominal pain was caused by pulling tumor with forceps. MRI revealed a tumor with a diameter of 2.5 cm on the left side of the cervix. We could not deny the possibility of cancer recurrence. Given these findings, she was suspected to have a fallopian tube prolapse into the vaginal vault or a relapse of the carcinoma. Diagnostic laparoscopy revealed that the vaginal tumor was causing prolapse of the left fallopian tube, Left salpingectomy was performed. Although the left fallopian tube and ovary were covered with a tissue film, the left fallopian tube was completely resected laparoscopically. The pathological findings of the resected tube showed no evidence of malignancy.

Conclusion: An appropriate operative management, such as keeping distance between the oviduct and anastomotic site, is necessary to prevent the prolapse of fallopian tubes into the vagina.