An ultrasound-guided minimally invasive treatment for vaginal vault collections following major gynaecological surgery: a case series
File(s)
Accepted version
Author(s)
Anson, Nicholas
Type
Journal Article
Abstract
Introduction:
Post-hysterectomy vaginal vault collections, often infected haematomas, cause significant morbidity
requiring resource-intensive and invasive management. Our proposed method for vault drainage, a
novel ultrasound-guided technique, aims to provide a minimally invasive treatment for refractory
collections. This is a proof-of-concept case series that describes the technique and evaluates its
potential efficacy.
Methods:
Retrospective case series of nine patients with vaginal vault collections (eight infected haematomas,
one lymphocyst) refractory to, or unsuitable for conservative management with intravenous
antibiotics. Transvaginal drainage with blunt sponge holding forceps was performed under transabdominal ultrasound-guidance, taking 3 to 5 minutes with minimal discomfort. Prior transvaginal ultrasound was performed to confirm collection anatomy. The primary outcomes were symptom resolution and inflammatory marker reduction. All patients were seen and treated at
Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Results:
All patients had their vaginal vault collection successfully drained with subsequent resolution of their
symptomatic illness (e.g. pyrexia, pain, discharge). One patient required repeat drainage. Inflammatory markers decreased significantly post-drainage. No procedure-related complications
occurred.
Discussion:
The proposed procedure treated all patients’ vaginal vault collections. This technique offers a minimally invasive, ultrasound-guided alternative to interventional radiology or surgery. This may particularly benefit high-risk patients such as we describe (e.g. high BMI, complex surgery, cancer diagnoses) who are less suitable for invasive intervention.
Conclusions:
We present an ultrasound-guided, minimally invasive technique for the treatment of refractory post-
hysterectomy vaginal vault collections that avoids the need for sharp instruments or surgical
intervention.
Post-hysterectomy vaginal vault collections, often infected haematomas, cause significant morbidity
requiring resource-intensive and invasive management. Our proposed method for vault drainage, a
novel ultrasound-guided technique, aims to provide a minimally invasive treatment for refractory
collections. This is a proof-of-concept case series that describes the technique and evaluates its
potential efficacy.
Methods:
Retrospective case series of nine patients with vaginal vault collections (eight infected haematomas,
one lymphocyst) refractory to, or unsuitable for conservative management with intravenous
antibiotics. Transvaginal drainage with blunt sponge holding forceps was performed under transabdominal ultrasound-guidance, taking 3 to 5 minutes with minimal discomfort. Prior transvaginal ultrasound was performed to confirm collection anatomy. The primary outcomes were symptom resolution and inflammatory marker reduction. All patients were seen and treated at
Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Results:
All patients had their vaginal vault collection successfully drained with subsequent resolution of their
symptomatic illness (e.g. pyrexia, pain, discharge). One patient required repeat drainage. Inflammatory markers decreased significantly post-drainage. No procedure-related complications
occurred.
Discussion:
The proposed procedure treated all patients’ vaginal vault collections. This technique offers a minimally invasive, ultrasound-guided alternative to interventional radiology or surgery. This may particularly benefit high-risk patients such as we describe (e.g. high BMI, complex surgery, cancer diagnoses) who are less suitable for invasive intervention.
Conclusions:
We present an ultrasound-guided, minimally invasive technique for the treatment of refractory post-
hysterectomy vaginal vault collections that avoids the need for sharp instruments or surgical
intervention.
Date Acceptance
2026-03-18
Citation
Frontiers in Surgery
ISSN
2296-875X
Publisher
Frontiers Media S.A.
Journal / Book Title
Frontiers in Surgery
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted