Sigmoido-uterine fistula: An uncommon communication!

Rodrigues, Gabriel; Janumpalli, Krishna Kalyan Reddy; Guruvare, Shyamala; Arjun, Suresh; Khan, Afroz; Jayasankar, Balaji

doi:10.1016/j.ejogrb.2019.06.002

Cited by 1 publication

(2 citation statements)

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“…It is postulated that colouterine fistula formation is not a frequent occurrence due to the thick muscular structure of the uterus that can usually provide a protective and firm barrier against an inflammatory or malignant disease, making its invasion or affection difficult. The aetiology of fistula involving the reproductive tract includes the rupture of an abscess into the adjacent viscera; malignant disease involving the gynaecologic, colon, or other pelvic organs; inflammatory bowel disease; surgery complications; and radiotherapy complications [7][8][9][10][11][12]. A colouterine fistula due to colonic chronic diverticular disease is less likely to occur.…”

Section: Discussionmentioning

confidence: 99%

“…The physical examination was also unrevealing, as is described in most similar cases in the literature. Abnormal uterine bleeding, a positive faecal occult blood test, and inflammatory colonic changes seen in colonoscopy are, in fact, the main clinical signs of inflammatory or cancerous disease involving the sigmoid colon and uterus [6,8]. Together, these signs should prompt clinicians to investigate with imaging modalities, namely gynaecological ultrasound and the appropriate colonic imaging, with CT being the most commonly used.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Colouterine Fistula as a Rare Cause of Postmenopausal Abnormal Uterine Bleeding: A Case Report

Silva,

Monteiro,

Barbosa

et al. 2024

JCM

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Postmenopausal abnormal uterine bleeding is a common clinical problem addressed in gynaecological practice and should prompt clinical investigation due to the significant prevalence of malignant and premalignant lesions of the endometrium in this age group. Nevertheless, other causes should be considered, since its diagnostic and therapeutic management may differ considerably. Here, we present a case of a colouterine fistula due to chronic diverticulitis presenting with postmenopausal abnormal uterine bleeding. This is an infrequent occurrence and is caused by the rupture of a diverticular abscess into the uterine wall, resulting in an inflammatory adhesion of the colon and uterus, with necrosis and subsequent fistula formation. The clinical presentation is variable and may include abdominal pain, gastrointestinal tract symptoms, vaginal discharge, and abnormal uterine bleeding. The laboratory and imaging techniques may be not completely conclusive and definitive diagnosis can be made intraoperatively. There are different treatment options, with en bloc resection and primary anastomosis being used most often, allowing complete treatment. The prognosis for a colouterine fistula secondary to diverticulitis is excellent after surgery. This case highlights the importance of clinical suspicion of an unusual cause of uterine bleeding and an effective and multidisciplinary approach that allowed complete surgical treatment and patient recovery.

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