MMK, a 24 year old P2L2 was referred to KEM Hospital for
bleeding per vaginum immediately after a laparoscopic tubal
ligation. She had two vaginal deliveries; last one was one
and half year back. She had an interval laparoscopic tubal
ligation done at a peripheral maternity hospital under local
anaesthesia and intravenous sedation and was found to have
bleeding per vaginum to the extent of soaking one fullsheet
four hours post tubal ligation. No vaginal procedure was
done other than insertion of Vitoon’s manipulator
for uterine manipulation.
The patient was Day 8 of menstrual cycle and past menstrual
cycles were regular. She was lactating. There was no medical,
surgical or drug history, contributing to the case.
Vaginal exploration was attempted at peripheral maternity
hospital but the bleeding site was not seen and so the
patient was transferred to KEM Hospital for further management
after packing the vagina with two roller packs.
On examination, patient’s general condition was
fair, peripheral pulse was 120/min, good volume. Blood
pressure - 100/70. She had pallor. Systemic examination
revealed no abnormality, patient was uncooperative and
did not allow examination without anaesthesia.
Under general anaesthesia two packs soaked with blood
were removed. Per speculum examination revealed a transverse
tear in the posterior fornix, 5 cm in length from one
lateral fornix to another with the culde-sac peritoneum
exposed (Fig. 1).
The tear was sutured by interrupted sutures with No 1-0
Patient was given one pint blood transfusion intraoperatively.
Post operative period was uneventful; speculum examination
done 3 weeks after surgery showed satisfactory healing.