Ileo-uterine fistula in a degenerated posterior wall fibroid after Caesarean section

Abstract

Uterine fibroids are benign tumors of the myometrium with a diverse range of manifestations. Fibroids can dramatically increase in size during pregnancy due to the increase in estrogen levels. After delivery, the fibroids usually shrink back to their pre-pregnancy size. Uterine myomas may have many complications, including abnormal uterine bleeding, infertility, pressure on nearby organs, degeneration, and malignant transformation. No previous reports have indicated that a fistula may develop between a uterine fibroid and the bowel loops, although previous studies have documented the occurrence of fistulas from the uterus to the bowel following myomectomy or uterine artery embolization performed to treat a myoma. In our case report, we document the rare complication of a fistula occurring between a degenerated myoma in the posterior wall and the ileum 1 week postoperatively in a patient who underwent a Caesarean section but did not have a history of uterine artery embolization.

An unusual case of ileo-uterine fistula discovered after full term normal delivery

“…These fistulas have been described in cases of gynecological cancers and cases of ulcerative colitis, and rarely following D and C procedures. [1][2][3] The fistula in our case most likely resulted from perforation of the uterus at the time of suction and curettage in the previous pregnancy. There is a case report of utero-rectal fistula manifesting during second trimester with massive GI bleeding.…”

“…They may result from obstetric or gynaecological procedures, pelvic tumours, inflammatory disease and post D and C perforation of the uterus. [1][2][3] A high index of suspicion is needed to diagnose this entity. CT and MRI are useful investigations to demonstrate the site and track of fistula.…”

Endometrial cavity-myoma fistula after uterine artery embolization diagnosed by pelvic MRI: case report

“…Limited number of cases of fistula has been reported in literature and they have been mainly with adjacent organs like bladder, ileum and colon [ [5] , [6] , [7] ]; nevertheless, connection with endometrial cavity is so rare with only few cases reported [ 8 ]. These cases have been found mostly in myomectomy [ 9 ] and specifically fistula to cavity hysteroscopy has been used as a means of diagnosis [ 8 , 9 ].…”