Abnormal uterine bleedingTransvaginal sonography Hysteroscopy Endometrial polyp Submucous fibroid a b s t r a c t Background: Abnormal uterine bleeding (AUB) accounts for 33% of female patients referred to gynaecologists. Common causes of AUB include endometrial polyps, endometrial hyperplasia, submucous fibroids and anovulation. Accurate diagnosis of the cause of AUB can reduce the frequency of hysterectomy. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Methods: 100 female patients with AUB were enrolled in the study. Each patient was subjected to TVS where uterine cavity was studied in detail and hysteroscopy under anaesthesia using saline as distension medium. Sensitivity, specificity and predictive value of TVS as compared to hysteroscopy were calculated. Subgroup analysis within each group was also performed. Results: Menorrhagia was the commonest presenting symptom in the study population (n ¼ 58) followed by metrorrhagia, menometrorrhagia and continuous bleeding >21 days. 74 female patients had normal size uterus. In 57 patients, the uterine cavity was normal on TVS. Thickened endometrium, endometrial polyp and submucous fibroids were seen in 19, 16 and 6 patients respectively. Hysteroscopy showed normal cavity in 59 female patients and polypoidal endometrium, polyps or submucous fibroids in 41. TVS was found to have high sensitivity and specificity (95.23 and 94.82 respectively) and high positive and negative predictive value. Strength of agreement between TVS and hysteroscopy was high (kappa value 0.898). Conclusion: TVS is recommended as first line investigation in AUB. If TVS shows normal cavity, further evaluation can be omitted and patient started directly on medical treatment for her symptoms.© 2014, Armed Forces Medical Services (AFMS). All rights reserved. m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 1 ( 2 0 1 5 ) 1 2 0 e1 2 5http://dx

Scar endometriosis is an extremely rare phenomenon. We presented a case of scar endometriosis in a thirty one year old patient (P2L2) who developed swelling and cyclical pain in the previous suprapubic caesarean scar (of previous two caesarean sections) area lasting for 10 days every month for last 2 years. On abdominal examination she had a small swelling at right margin of the wound which was firm and tender on examination with dull aching constant pain at the site of examination. This pain used to aggravate with menses. Investigations suggested scar endometriosis and she was treated medically with oral contraceptives and GnRH but symptoms recurred on stopping the treatment. Patient underwent surgery. A dense fibrotic tissue of 5×4×5 cm size including the rectus sheath, part of rectus muscles and subcutaneous tissue was found on the right side of the old previous scar beneath the skin which was excised and sent for histopathological examination which reconfirmed the diagnosis of scar endometriosis with presence of glands and stroma in the excised tissue. Post-operative period was uneventful.