Differential Diagnosis for Post-Hysterectomy Vaginal Bleeding
Single Most Likely Diagnosis
- Postoperative hemorrhage: This is the most common cause of vaginal bleeding after a hysterectomy, often due to incomplete ligation of blood vessels or dislodgement of clots from the surgical site.
Other Likely Diagnoses
- Infection or endometritis: Infection of the surgical site or the remaining vaginal tissue can cause bleeding, especially if there is a collection of pus or an abscess.
- Vaginal cuff dehiscence: A partial or complete separation of the vaginal cuff closure can lead to bleeding, and may require surgical intervention.
- Hematoma or abscess formation: Collection of blood or pus at the surgical site can cause bleeding and may require drainage.
Do Not Miss Diagnoses
- Pulmonary embolism: Although not directly related to vaginal bleeding, postoperative patients are at increased risk for pulmonary embolism, which can be life-threatening if missed.
- Sepsis: Infection can quickly progress to sepsis, especially in post-surgical patients, and requires prompt recognition and treatment.
- Ureteral injury: Injury to the ureters during hysterectomy can cause bleeding, and may require urgent surgical intervention to prevent long-term damage.
Rare Diagnoses
- Vaginal cancer: Although rare, vaginal cancer can cause bleeding, especially if the patient has a history of cervical or other gynecologic cancers.
- Arteriovenous malformation: Abnormal connections between arteries and veins can cause bleeding, and may require embolization or surgical intervention.
- Coagulopathy: Underlying bleeding disorders, such as von Willebrand disease or hemophilia, can increase the risk of postoperative bleeding.