I had read about posthysterectomy fimbrial prolapse in Jeffcoate’s Gynecology as an undergraduate student. It was stated that it could occur due to improper closure of the pelvic peritoneum after a hysterectomy, vaginal rather than abdominal. It was also stated that it was such a rare occurrence, that whenever one saw something like it, one should diagnose vault granulations rather than fimbrial prolapse. After all, statistics is more accurate than one’s personal feelings. I followed that rule all my life and was never proved wrong. Time and again a hopeful resident doctor or a young lecturer would show me a case and call it fimbrial prolapse. Perhaps it was wishful thinking, wanting to cut the vagina all around it, excising it, and then repairing the defect in the vagina, as was described by Jeffcoate. I would tell them it was vault granulation, they would not believe me (as young people tend to do with all seniors), I would hold it with sponge holding forceps, it would come off easily, and I would tell tem to send it for histopathological examination to confirm that I was right. A couple of weeks later they would come to me with the histopathology report showing it was granulation tissue, and I would give them a ‘henceforth-it-will-be-better-if-you-remember-I-am-smarter-and-it-would-be-better-to-believe-me’ look. But the other day one lecturer called me to see a fimbrial prolapse that looked different from the many I had been shown before. I hald I gently with a sponge-holding forceps and made traction.
“Ouch!” she said, while the mass showed no sign of separating out.
“This is fimbrial prolapse” I said. I performed a bimanual pelvic examination, and found that she had an ovarian tumor too. We performed an exploratory laparotomy to remove the ovarian mass, prior to which I removed the prolapsed lateral part of the fallopian tube vaginally so as not to contaminate the peritoneal cavity later by its abdominal removal. Histopathological examination confirmed the diagnosis of fimbrial prolapse.
I am unlikely to see another case in my lifetime, and cannot add statistics to support this new sign. But I can confidently say that if the fimbriae-like mass comes off very easily when held with a sponge-holding forceps, it will be granulation tissue in the vault of vagina, while if it does not and the woman experiences pain when traction is made on it, it will be fimbriae.
