Author information
Parulekar SV
(Professor and head of the department,
Department of Obstetrics and Gynecology, Seth GS Medical College and KEM
Hospital, Mumbai, India.)
Abstract
Prolapse of the fimbria of the fallopian
tube is a rare complication of hysterectomy. It has a number of differential
diagnoses. A biopsy is diagnostic. There are no clinical tests described to
diagnose it. A clinical test is described here to make a diagnosis of
posthysterectomy fimbrial prolapse.
Introduction
The incidence of fimbrial prolapse after
hysterectomy is less than 1% of all hysterectomies, and hence one does not
encounter too many cases in a lifetime.[1,2] There are no tests
described to make an accurate diagnosis and hence the diagnosis is usually made
by appearance of the lesion. But it resembles a number of conditions like
granulation tissue in the vault, primary or metastatic adenocarcinoma, endometriosis,
cysts of the mesonephric and paramesonephric ducts and vaginal adenosis.[3,4]
A biopsy is diagnostic. But to have to use a surgical procedure for making the primary
diagnosis is not desirable. A clinical test is described to make a diagnosis of
posthysterectomy fimbrial prolapse.
Traction Test
A speculum examination is done.
The lesion is exposed well. It is held with sponge holding forceps. Gentle
traction is made. In case of a prolapse of fimbria of the fallopian tube, the
patient experiences a sharp dragging sensation in the pelvis, on the side of
the prolapse of the tubal fimbria. Care has to be taken not to traumatize the
fimbriae, which can cause bleeding. In case of vault granulations, they come
off easily without causing any discomfort. There is mild bleeding after
separation of the granulations, which soon stops. In case of the other lesions,
they do not come off, nor do they cause any discomfort or pain.
Discussion
Usually the lateral end of
the fallopian tube prolapses in the form of one or more fimbriae. The prolapsed
part is in continuity with the rest of the fallopian tube, which has its nerve
supply intact. As a result, when the prolapsed part is held with sponge holding
forceps and traction is made, it gets transmitted to the non prolapsed part of
the tube and causes a dragging sensation and/or pain. This test is positive
even if there is fibrosis between the vault and the tube that has prolapsed
through a defect in it. Granulation tissue is soft and easily gets detached on
traction. Other lesions do not show either of these findings. The appearance of
an adenocarcinoma can be surprisingly like a fimbria, and distinction needs to
be made in order to treat the patient adequately. The lesions of adenocarcinoma also
get detached readily on traction. Histopathological examination differentiates
the two from each other. There is some risk of bleeding after removal of a part
of an adenocarcinoma. Hence the test is best performed in a procedures room or
minor operation theater if an adenocarcinoma is suspected from other clinical
findings.
Conclusion
Traction test is a simple
clinical test that makes the diagnosis of posthysterectomy prolapse of the
fallopian tube easy and accurate.
References
1.
Fan
QB, Liu ZF, Lang JH, et al. Fallopian tube prolapse following hysterectomy.
Chin Med Sci J. 2006;21(1):20-23.
2.
Ramin SM, Ramin KD, Hemsell DL. Fallopian tube prolapse after hysterectomy. South Med
J 1999;10:963–966.
3.
Ouldamer
L, Caille A, Body G. Fallopian Tube Prolapse after Hysterectomy: A Systematic
Review. PLOS ONE 2013;8(10):e76543.
4.
Song YS, Kang JS, Park MH. Fallopian tube prolapse misdiagnosed as vault
granulation tissue: a report of three cases. Pathol Res Pract 2005;201(12):
819-822. doi:10.1016/j.prp.2005.09.001.
Citation