An Unusual Complication After Vaginal Hysterectomy

Background: Uterovaginal prolapse is a common problem in older women, with significant economic and health implications. For the patient no longer desiring fertility or unwilling to undergo conservative management, the definitive treatment is a vaginal hysterectomy with simultaneous repair of anterior or posterior compartment defects if present. Case: A 66-year-old postmenopausal woman with procidentia, cystocele, rectocele, and latent stress incontinence underwent vaginal hysterectomy, anterior and posterior colporrhaphy, and placement of a modified mid-urethral sling. Perioperatively she sustained a fracture of the pubic ramus that was not explained by perioperative events or her medical history. Conclusion: Unusual and unexpected complications can occur after routine vaginal surgery in the older, postmenopausal population.