Cervical Stenosis: A Challenging Clinical Entity

Abstract

Cervical stenosis can be a difficult clinical condition to treat effectively, and treatment may be followed by recurrences. Thirty-seven (37) women with this clinical diagnosis were evaluated and treated in our service over the last 5 years. Fifteen (15) women (43.2%) had previous cervical surgery such as conization, loop electrosurgical excision procedure (LEEP), or cervical laser vaporization and 11 had a history of diethylstilbestrol (DES) exposure. After treatment, 28 (75.5%) of these women obtained relief while in 24.5% no changes occurred. Four women (14.2%) had recurrence. Based on our experience, sequential progressive cervical dilatation under sonographic or laparoscopic control seems to add safety and effectiveness in the treatment of this condition. For those patients who develop recurrences, laser removal of a cervical central cylinder of tissue seems to provide the best results. Avoiding excessive trauma to the cervix with any surgical procedure should be paramount in decreasing chances of causing cervical stenosis, particularly in susceptible patients such as nulliparous and DES-exposed women. (J GYNECOL SURG 18:129)

Hematometra and Hematocolpos, Secondary to Cervical Canal Occlusion, a Case Report and Review of Literature

“…More study on this subject would be ideal. Valle et al [13] obtained favorable results with the removal of a cervical central cylinder of tissue for patients with recurrences [13]. Factors that predispose to recurrent cervical stenosis should be further studied to aid in the development of an effective treatment algorithm for such patient.…”

“…Ablating the cervico-uterine junction is possible in certain cases, likely owed to poor surgical technique [12]. Cervical stenosis may present as a late complication of extensive resection or trauma to the cervical os, and presentation will vary depending on degree of obstruction [13]. Cervical conization is associated with a high risk of stenosis with a rate of 1.3% to 25% [13].…”

“…Cervical stenosis may present as a late complication of extensive resection or trauma to the cervical os, and presentation will vary depending on degree of obstruction [13]. Cervical conization is associated with a high risk of stenosis with a rate of 1.3% to 25% [13]. In contrast Suh-Burgmann et al [8] reported a 6% rate of cervical stenosis after LEEP [8].…”

“…Our patient developed hematometra/ hematocolpos due to postoperative cervical stenosis, as explained throughout this report. Ultrasound and MRI are two imaging modalities that can be used in the diagnosis of hematometra [3,5,13]. With ultrasound the uterus can be seen as an enlarged pelvic mass with an echo free lumen due to the presence of blood [14].…”

“…With ultrasound the uterus can be seen as an enlarged pelvic mass with an echo free lumen due to the presence of blood [14]. Diagnosis of cervical stenosis can also be made by the inability to pass a 2.5 mm Hegar dilator through the cervical os [13]. Physical exam may reveal a palpable mass or enlarged uterus [1].…”