Background:
We have, herein, presented a case of an uterocutaneous fistula after cesarian
delivery.
Case Presentation:
A 24-years old female, gravida 3 para 3 with 2 living children, who underwent an
emergency cesarean section about one month before the term due to preterm labor at Hamedan, was
diagnosed with uterocutaneous fistula. Her medical history included 2 previous term cesarean section
deliveries. She reported having fever and chills three weeks after the cesarian delivery. She also developed nausea, vomiting, and epigastric pain. Abdominal examination revealed a 30×40mm, firm,
and tender mass on the right side of the cesarian section suture without any discharge. She was admitted with metritis as a primary diagnosis at N.H.F hospital. The performed transvaginal ultrasonography reported a hetero-echo mass with a diameter of 38×30×37mm with several echogenic foci and
cystic components in the right ovary. After that, an abdominopelvic CT scan was done, and a
30×40mm mass in the right ovary with non-homogeneous due to collection and abnormal density with
local hematoma at the site of the previous cesarian section was reported. Due to suspicion of lesion,
the surgery was performed with the diagnosis of fascia opening and right Tubo-ovarian abscess and
the infectious discharge of the right ovary. Right salpingo-oophorectomy surgery was performed. She
was admitted again with the complaint of infectious discharge from the right side of the suture and erythema for one month. She also developed generalized abdominal pain. The patient was, thus, diagnosed with a uterocutaneous fistula and was admitted to the center. She became a trans-abdominal
hysterectomy candidate and underwent surgery.
Conclusion:
One of the important risk factors for the fistula to be formed is an abscess. A few cases
have been reported of post-cesarean uterocutaneous fistula in the literature. Surgical treatment associated with medical therapy can be effective in women with multiple cesarian sections. Any infected dehiscence must be radically operated.
A 26-year-old woman at 30 weeks of gestation referred due to PPROM. From
second day after CS, the patients fever increased and Doppler sonography
shows low fluid and hematoma in the uterus. Wound debridement conducted
and during laparotomy the adhesions were released. The Wright-Coombs 2ME
showed infection to brucellosis.
We report a 33 years multipara pregnant woman who presented with vaginal bleeding due to intramural myoma and preeclampsia. After cesarean section, the myoma changed to the peduncle type and entered the internal space from the inner thickness of the uterus. This infrequent phenomenon made it easier to operate and remove the myoma within a few hours after the cesarean section. Finally, the mother and baby were discharged from the hospital safely after a few days.
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