HYSTEROSCOPIC TREATMENT OF ECTOPIC INTRAUTERINE BONE - A CASE-REPORT

Hysteroscopic removal of ectopic bone in the uterus, using laparoscopi c control and ultrasonographic confirmation, was used to treat a patie nt who presented with a diagnosis of osseous metaplasia of the uterus. Pathologic analysis revealed benign bony tissue consistent with a dia gnosis of osseous metaplasia. Laparoscopy and hysteroscopy confirmed t he presence of bone in the form of spicules perpendicular to the uteri ne endometrium. Most of the bone was present in the posterior portion of the fundus. Initial removal was performed with biopsy forceps follo wed by gentle curettage. The resectoscope was then introduced to visua lize any remaining spicules and remove them by mechanical means with m inimal use of electrosurgery. Transvaginal ultrasound assisted in iden tifying bone and confirming its removal during and after surgery. The hysteroscopic procedure was viewed laparoscopically to reduce the risk of uterine perforation. Dense right adnexal adhesions were also lysed . The patient received conjugated equine estrogens for five weeks post operatively. Ultrasound showed an intrauterine pregnancy of 5 to 6 wee ks plus two small calcifications approximately 1 mm each. The patient delivered a healthy infant and has had no recurrent problems. This cas e report demonstrates the successful use of multiple diagnostic and tr eatment modalities in the treatment of ectopic intrauterine bone.