CLINICAL FEATURES A vaginal cuff is formed during a hysterectomy and is composed of the contiguous retroperitoneal space immediately above the vaginal apex and the surrounding soft tissue. This cuff may become infected, leading to cellulitis, hematoma, or abscess.
Vaginal cuff cellulitis is a common complication following both abdominal and vaginal hysterectomy. Symptoms and signs usually present between postoperative days 3 and 5, and may begin in the hospital, or just after discharge. Patients often complain of lower abdominal pain, pelvic pain, back pain, fever, and abnormal vaginal discharge. Induration, tenderness of the vaginal cuff, and possibly a purulent discharge or labial edema or erythema are prominent during the pelvic examination. The white blood cell count is usually elevated.
A vaginal cuff abscess usually presents early in the postoperative course. Patients complain of fever, chills, pelvic pain, and rectal pressure. On examination, lower abdominal and vaginal cuff tenderness is present. A tender fluctuant mass near the cuff may be palpable, and purulent drainage from the cuff may be seen.
Infected cuff hematomas may present later in the postoperative course and are associated with a decrease in the patient's hemoglobin and hematocrit levels. The hematoma may not be palpable on examination.
DISPOSITION Patients should be readmitted for drainage and intravenous antibiotics. Broad-spectrum antibiotics should be started early, with coverage for gram-negative, gram-positive, and anaerobic organisms. A CT scan may be necessary for diagnosis or to better define an abscess or hematoma.
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