Delayed pain after global endometrial ablation (GEA) is usually caused by hematometra.

摘要

To the Editor: The article by Carey et al [1] confirms what recently published literature [2] has observed: that delayed pain after global endometrial ablation (GEA) is usually caused by hematometra, not adenomyosis. Although the frequency of hematometra was observed to be significant, the incidence may have been understated for 2 reasons. First, as appropriately mentioned, the "routine" pathologic workup of a uterus after ablation is inadequate. Surgeons must specifically tell the pathologist to serially section the proximal oviducts and cornua, which are sections not routinely taken. Otherwise, cornual hematometra, postablation tubal sterilization syndrome, and endosalpingoblastosis may be missed. Second, if the hysterectomy or preoperative imaging study is not performed during the menstrual phase of a patient's cycle, cornual hematometra and postablation tubal sterilization syndrome can be missed. It has been observed that the blood in the hematometra or hematosalpinx often is absorbed during the remainder of the month, and the diagnosis can be missed. These problems are thoroughly discussed in a recently published review article on the long-term complications of GEA [2].