Endometrial ablation: postoperative complications

Endometrial Ablation: Normal Imaging Appearance and Delayed Complications

“…This ingrowth often results in extensive intrauterine scarring and adhesions that subsequently lead to uterine contracture, chambering, and potentially obliteration of the intrauterine cavity. These changes become clinically significant when obstructed bleeding from functional residual or regenerating endometrium occurs behind areas of intrauterine scarring or adhesions [35,36]. This process is the pathologic basis for the development of the manifestations of painful obstructed menses, and it can occur after ablation with all devices that result in the thermal destruction of the endometrial lining [37][38][39].…”

“…An attempt at local drainage and resection of the residual endometrium at the cornua can be performed via ultrasound-guided hysteroscopy, although there is a risk of perforation of the thinned myometrium in the cornual region. Definitive treatment of cornual hematometra often requires hysterectomy [35,36].…”

“…7 and 8). Hysterectomy with proximal salpingectomy is the definitive treatment, and drainage of the hematosalpinx and cornual blood is rarely attempted [35,42].…”

Sonographic Findings in Postmenopausal Women With a Prior Endometrial Ablation: Interpretation and Management of Women With Endometrial Thickening and Bleeding

“…EA is related to a wide range of amenorrhea rates (13.9%-55.3%) [5,6]. Within 3 to 12 months after surgery, both first-and second-generation ablative methods induce intrauterine scarring and contracture, but rarely is the whole endometrium destroyed, as demonstrated by magnetic resonance imaging studies showing the presence of endometrial tissue in up to 95% of patients undergoing ablation, including those with amenorrhea [6,7].…”

“…EA is related to a wide range of amenorrhea rates (13.9%-55.3%) [5,6]. Within 3 to 12 months after surgery, both first-and second-generation ablative methods induce intrauterine scarring and contracture, but rarely is the whole endometrium destroyed, as demonstrated by magnetic resonance imaging studies showing the presence of endometrial tissue in up to 95% of patients undergoing ablation, including those with amenorrhea [6,7]. Furthermore, intrauterine scarring and contracture limit any bleeding from persistent or regenerating endometrium just behind the scar, which can cause such complications as cyclic pelvic pain, central hematometra, cornual hematometra, postablation tubal sterilization syndrome, and retrograde menstruation in premenopausal women [6,8].…”