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Introduction and Hypothesis <p>Postoperative bleeding is a recognized, potentially life-threatening complication after pelvic surgery. This case describes the management of such an event using laparoscopic techniques following vaginal hysterectomy for pelvic organ prolapse (POP), highlighting the importance of early detection and intervention, even with altered postoperative anatomy.</p> Methods <p>A 63-year-old woman underwent a vaginal hysterectomy, apical support with McCall culdoplasty, bilateral salpingo-oophorectomy (BSO), anterior and posterior colporrhaphy (APC), and a trans-obturator tape (TOT) procedure for POP. Evaluation before surgery was performed using the Pelvic Organ Prolapse Quantification system: Ba +2&#xa0;cm, C +4&#xa0;cm, Bp +1&#xa0;cm, TVL 11&#xa0;cm. On postoperative day 1, she reported severe abdominal pain; blood work showed a drop in her hemoglobin levels, and imaging confirmed intra-abdominal bleeding. Despite receiving two units of packed red blood cells, her hemoglobin continued to decline, necessitating exploratory laparoscopy. In this case, the laparoscopic approach improved visualization while allowing for precise identification and management of the bleeding source. The observed vaginal cuff hematoma was drained, the retroperitoneum was accessed bilaterally using the white line of Toldt as an anatomical landmark to develop the avascular spaces; then, the ureters were identified, and hemostasis was achieved by coagulating the infundibulopelvic ligaments and clipping the uterine arteries.</p> Results <p>The patient received two additional units of blood during surgery and experienced no additional events in the postoperative recovery time. She remained hemodynamically stable with no further complications.</p> Conclusions <p>Laparoscopic intervention for postoperative hemorrhage after vaginal hysterectomy is a safe and effective approach. Early detection and prompt management of intra-abdominal bleeding can prevent additional morbidity. Identifying and securely closing the uterine arteries are crucial for controlling bleeding, especially when anatomical changes from previous surgery are present.</p>

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Laparoscopic Management of Intra-Abdominal Bleeding Following Vaginal Hysterectomy, Bilateral Salpingo-Oophorectomy and Pelvic Organ Prolapse Surgery

  • 期刊论文

  • 发表日期：

    2025年12月11日

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  • Matan Friedman,
  • Tally Levy,
  • Masha Ben-Zvi,
  • Ehud Grinstein,
  • Shimon Ginath

摘要

Introduction and Hypothesis

Postoperative bleeding is a recognized, potentially life-threatening complication after pelvic surgery. This case describes the management of such an event using laparoscopic techniques following vaginal hysterectomy for pelvic organ prolapse (POP), highlighting the importance of early detection and intervention, even with altered postoperative anatomy.

Methods

A 63-year-old woman underwent a vaginal hysterectomy, apical support with McCall culdoplasty, bilateral salpingo-oophorectomy (BSO), anterior and posterior colporrhaphy (APC), and a trans-obturator tape (TOT) procedure for POP. Evaluation before surgery was performed using the Pelvic Organ Prolapse Quantification system: Ba +2 cm, C +4 cm, Bp +1 cm, TVL 11 cm. On postoperative day 1, she reported severe abdominal pain; blood work showed a drop in her hemoglobin levels, and imaging confirmed intra-abdominal bleeding. Despite receiving two units of packed red blood cells, her hemoglobin continued to decline, necessitating exploratory laparoscopy. In this case, the laparoscopic approach improved visualization while allowing for precise identification and management of the bleeding source. The observed vaginal cuff hematoma was drained, the retroperitoneum was accessed bilaterally using the white line of Toldt as an anatomical landmark to develop the avascular spaces; then, the ureters were identified, and hemostasis was achieved by coagulating the infundibulopelvic ligaments and clipping the uterine arteries.

Results

The patient received two additional units of blood during surgery and experienced no additional events in the postoperative recovery time. She remained hemodynamically stable with no further complications.

Conclusions

Laparoscopic intervention for postoperative hemorrhage after vaginal hysterectomy is a safe and effective approach. Early detection and prompt management of intra-abdominal bleeding can prevent additional morbidity. Identifying and securely closing the uterine arteries are crucial for controlling bleeding, especially when anatomical changes from previous surgery are present.