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Age: 45

Sex: Female

Indication: Pelvic pain, negative pregnancy test

Remote history of endometrial ablation and bilateral tubal ligation

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Case #32


Findings

  • Heterogeneous echotexture of the myometrium with globular appearance of the uterine fundus and poor definition of the endometrial/myometrial interface
  • Fluid in the endometrial canal extending along the cornua and into the left fallopian tube
  • No focal mass identified
  • C-section scar
  • Cystic structure with internal septation in the left ovary measuring 3.4 x 3.3 x 3 cm
  • Normal appearance of the right ovary
  • No free fluid in the cul-de-sac


Diagnosis

Postablation tubal sterilization syndrome (PATSS)

Sample Report

Findings of extensive adenomyosis with left hydrosalpinx and cornual hydrometra, which given the history of endometrial ablation and bilateral tubal ligation and the complaint of pelvic pain is most suggestive of postablation tubal sterilization syndrome (PATSS).

Mildly complex cyst in the left ovary measuring up to 3.4 cm. Recommend followup pelvic ultrasound in 6-12 weeks for further assessment.


Discussion

  • Postablation tubal sterilization syndrome (PATSS) is a potential delayed complication of endometrial ablation where physiologic blood products in the fallopian tubes and uterine cornua may become obstructed due to postprocedural adhesions, which can lead to cyclic pain
  • Think about this diagnosis if you see hematosalpinx/hydrosalpinx and cornual hematometra/hydrometra in a patient with history of endometrial ablation and tubal ligation who presents with pain
  • The definitive management is hysterectomy and partial salpingectomy, which can be considered if conservative management fails
  • Reference the Incidental Findings Guidelines for management guidelines for incidentally discovered ovarian cysts



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