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Review
. 2023 Nov 15;69(3):197-204.
doi: 10.5387/fms.2023-04. Epub 2023 Oct 17.

A case of delayed postoperative bleeding after excision of endometrial polyp using resectoscope in an infertile woman with von Willebrand disease:a case report and literature review

Chihiro Okoshi  1 , Toshifumi Takahashi  2 , Masahiko Fukatsu  3 , Ryota Suganuma  1 , Takayuki Ikezoe  2 , Keiya Fujimori  1
Affiliations
Review

A case of delayed postoperative bleeding after excision of endometrial polyp using resectoscope in an infertile woman with von Willebrand disease:a case report and literature review

Chihiro Okoshi et al. Fukushima J Med Sci. .

Abstract

Von Willebrand disease (VWD) is a bleeding disorder caused by a congenital quantitative reduction, deficiency, or qualitative abnormality of the von Willebrand factor (VWF). Here, we report a case of delayed postoperative bleeding in an infertile woman with endometrial polyps complicated by VWD. The patient was a 39-year-old infertile woman with type 2A VWD. At 38 years of age, she was referred to our hospital for infertility and heavy menstrual bleeding. Hysteroscopy revealed a 15-mm polyp lesion in the uterus. The patient was scheduled for transcervical resection (TCR) of the endometrial polyp. Gonadotropin-releasing hormone agonists were preoperatively administered to prevent menstruation. The VWF-containing concentrate was administered for 3 days according to guidelines. The patient was discharged on postoperative day 3 after confirming the absence of uterine bleeding. Uterine bleeding began on postoperative day 6. The patient was readmitted on postoperative day 7 and treated with VWF-containing concentrate for 5 days, after which hemostasis was confirmed. TCR surgery for endometrial lesions is classified as a minor surgery, and guidelines recommend short-term VWF-containing concentrate replacement. However, it should be kept in mind that only short-term VWF-containing concentrate replacement may cause rebleeding postoperatively.

Keywords: endometrial polyp; polypectomy; uterine bleeding; von Willebrand disease.

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Figures

Fig. 1.
Fig. 1.
Transvaginal ultrasonography shows a 15×13 mm hyperechoic lesion of the uterus (a). Photographs of transcervical resection of the endometrial polyp. The endometrial polyp attaches to the posterior wall of the uterus (b, c). Photograph of hemostasis using a ball electrode after endometrial polypectomy by cutting electrode (d).
Fig. 2.
Fig. 2.
Macroscopic appearance of resected specimen (a). White bar = 10 mm. Microscopic histology of resected specimen (b: low power magnification, c: high power magnification). Black bar = 500 µm.
Fig. 3.
Fig. 3.
Photographs of transvaginal ultrasonography after 1 day (a) and 6 days (b) from the transcervical resection of the endometrial polyp. A photograph taken on the sixth postoperative day shows a mass in the uterus that appears to be filled with a clot in the uterus (b).
Fig. 4.
Fig. 4.
A schematic clinical treatment course in an infertile woman with endometrial polyp complicated by von Willebrand disease. TCR: transcervical resection, VWF: von Willebrand factor, VWF: Ag: von Willebrand factor antigen, VWF: RCo: von Willebrand factor ristocetin cofactor activity, APTT: activated partial thromboplastin time, Hb: hemoglobin, FVIII: coagulation factor VIII.
See this image and copyright information in PMC

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