Hysteroscopic treatment of ectopic intrauterine bone. A case report.

Hysteroscopic removal of ectopic bone in the uterus, using laparoscopic control and ultrasonographic confirmation, was used to treat a patient who presented with a diagnosis of osseous metaplasia of the uterus. Pathologic analysis revealed benign bony tissue consistent with a diagnosis of osseous metaplasia. Laparoscopy and hysteroscopy confirmed the presence of bone in the form of spicules perpendicular to the uterine endometrium. Most of the bone was present in the posterior portion of the fundus. Initial removal was performed with biopsy forceps followed by gentle curettage. The resectoscope was then introduced to visualize any remaining spicules and remove them by mechanical means with minimal use of electrosurgery. Transvaginal ultrasound assisted in identifying 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 weeks plus two small calcifications approximately 1 mm each. The patient delivered a healthy infant and has had no recurrent problems. This case report demonstrates the successful use of multiple diagnostic and treatment modalities in the treatment of ectopic intrauterine bone.