Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2007, Article ID 91708, 3 pages doi:10.1155/2007/91708 Clinical Study Sonographically Diagnosed Vault Hematomas Following Vaginal Hysterectomy and Its Correlation with Postoperative Morbidity Cem Dane, Banu Dane, Ahmet Cetin, and Murat Yayla Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, 34019 Istanbul, Turkey Received 29 September 2006; Accepted 4 January 2007 Objective. Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity. Methods. We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound ﬁndings were correlated with clinical data and postoperative morbidity. Results. The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20) had fever while only 2.4% (2/83) of cases without vault hematoma suﬀered from fever. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma. Fifty percent of patients (3/6) with large-sized hematoma, as compared to only 35% (5/14) with small-sized hematoma, suﬀered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The signiﬁcant diﬀerence was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group. Conclusion. Sonographic detection of vaginal vault ﬂuid collection is common after hysterectomy, but such a ﬁnding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be signiﬁcant. Vaginal ultrasound examination should not be performed routinely after hysterectomy. Copyright © 2007 Cem Dane et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. INTRODUCTION Gynecologists for uterovaginal prolapse preferred vaginal hysterectomy where anterior colporrhaphy and posterior colpoperineorrhaphy can be conveniently performed. This route is associated with less febrile morbidity, less risk of hemorrhage, fewer blood transfusions, shorter hospitaliza- tion, and quick convalescence as compared to abdominal route [1–3]. Even with this procedure, some complications like hemorrhage, postoperative fever, and infection were re- ported. The incidence of vault hematoma after vaginal hys- terectomy is variably reported—from approximately 25% to as much as 98% [4–6]. Such disparity in diagnosis may be due to diﬀering deﬁnitions of vault hematoma and/or di- agnostic modalities. There are many applications of ultra- sonography in gynecology, although they are less crucial than in obstetrics. Role of ultrasonography in routine evaluation of post-hysterectomy patients is new and the role is not well deﬁned. Transabdominal sonography may be used to de- tect, and eventually guide the drainage of ﬂuid collections. The present study focused on vaginal hysterectomy patients having transabdominal ultrasound to ﬁnd the incidence of postoperative vault hematoma and its correlation with post- operative morbidity. 2. MATERIALS AND METHOD The study was initiated as a prospective-observational study at Education and Research Hospital, during the period of January 2003 to January 2005 where 103 consecutive women who underwent vaginal hysterectomy, with pelvic ﬂoor re- pair operations. Each woman gave consent to the study be- fore the operation. In each case, similar operative techniques were employed by a variety of experienced surgeons. The vaginal vault was closed and not reperitonealised. Women received a single dose of intravenous antibiotics at time of surgery. Amount of blood loss, units of blood transfused, and operating time were recorded for every patient. Postoperative morbidity was assessed by the following parameters which include postoperative fever, drop in hemoglobin (preopera- tive to third day after operation), and need for blood transfu- sion (excluding those transfused for preoperative anaemia).