Vaginal stump endometriosis following total laparoscopic hysterectomy: A case report

A 40-year-old G0P0 presented with uterine leiomyomas and underwent total laparoscopic hysterectomy and bilateral salpingectomy for management of worsening hypermenorrhea. Intraperitoneal findings included an endometriotic lesion (approximately 1 cm) in the peritoneum of the Douglas pouch and partial adhesion. The vaginal canal was incised, and the uterus was transected and removed after transvaginal morcellation. Histopathological examination of the resected specimen revealed uterine leiomyoma without salpingeal abnormalities or endometriotic lesions. The patient observed monthly genital bleeding, 2 and 5 months postoperatively; however, no apparent clinical abnormalities were detected. She experienced similar genital bleeding accompanied by periumbilical pain, 9 months postoperatively. Colposcopy revealed several red endometriosis-like lesions involving the vaginal stump, and the patient was diagnosed with vaginal stump endometriosis. Oral dienogest administration initiated at 11 months postoperatively was continued as maintenance therapy, and the patient's symptoms nearly resolved 5 months later.