Iatrogenic endometriosis due to isthmic stenosis post-trachelectomy.

Abstract

A nulliparous 42-year-old woman presented for a prophylactic prepregnancy laparoscopic transabdominal cerclage (suture around the cervicoisthmic junction to prevent pregnancy loss due to cervical insufficiency) after having undergone a trachelectomy for stage IA cervical cancer 10 years ago. The patient had a laparoscopy for investigation of pelvic pain a couple of years before the trachelectomy. Mild superficial endometriosis was reported and treated at the time. She had been having regular menstrual cycles until the trachelectomy and became permanently amenorrhoeic postsurgery. Blood tests done prior to the procedure showed normal ovarian and thyroid functions. She did not undergo chemotherapy or radiotherapy that could have contributed to reduction in ovarian activity and hence cessation of menses. She has recently started In-vitro fertilisation (IVF) treatment for infertility attributed to anatomical factors (stenosed cervix). All hormonal investigations came back within normal range, again confirming adequate ovarian function. There was no transvaginal access to the endometrial cavity due to cervical stenosis.