Uterocutaneous fistula after cesarean section; Case report

Abstract

Introduction and importance Fistula is an abnormal tract communicating two epithelial surfaces, uterocutaneous fistula is an extremely rare. The classical presentation is cyclical bleeding from an abnormal opening in the scar of previous cesarean section. Case presentation A 28 year-old was presented 6 months after cesarean section with history of severe pain and blood discharge during menstruation from the previous transverse supra-pubic scar. The patient had history of previous 2 cesarean sections. Abdominal examination revealed a localized tenderness at site of previous operation scar with 1*1 cm opening at the central part of the scar which was discharging blood during pressure over the lower abdomen. There was no urine discharge from the scar. Vaginal examination by the speculum was normal. Clinical discussion Endometriosis was suspected and the patient received medical treatment with little improvement. Later, surgical intervention was done, the scar was excised with an abnormal fistulous tract connecting endometrial cavity at the site of the previous scar was found. Complete excision of the tract was done and the uterus was re-sutured using a slowly-absorbable suture material. The patient had no complications with regular cycles. Conclusion Uterocutaneous fistula is rare and usually follow cesarean section, suturing the uterus with non-absorbable suture material is reported in this case to be one of the underlying causes, other causes include infection, necrosis, foreign bodies, or malignancy. The fistula tract must be defined and any associated infection controlled, complete resection of the fistulous tract and suturing the uterus with absorbable suture material is required.

Utero-cutaneous fistula following caesarean section

“…Various imaging techniques are used. However, a fistulogram with either CT or MRI in the sagittal sections would give a clear diagnosis 7. Hysteroscopy helps us visualise the inner opening of the fistula.…”

Medical management of small uterocutaneous fistulae with gonadotrophin releasing hormone analogs: Case report and literature review

“…2 Pathogenesis of UCF is multifactorial but initial iatrogenic disruption of the integrity of the uterine wall, subcutaneous tissue, and skin, further compounded by subsequent infective necrosis are likely contributory factors. Typical pelvic surgical procedures associated with UCF include CS 1,2 and open myomectomy 7,9 as in both of these, a potential channel is created between the uterus and the abdominal skin. The mechanism of action of leuprolide in this case is unclear but we postulate that it produces endometrial atrophy, leading to contracture, fibrosis, and eventual closure of the fistulous tract.…”

“…Traditional surgical treatment for UCF includes either open 1 or laparoscopic excision 2 of the fistulous tract but more radical strategies such as hysterectomy have also been reported. 3 Our case report illustrates that surgical intervention is not always necessary and there is increasing recognition of successful medical treatment with GnRH agonists such as leuprolide 4 and triptorelin.…”

Uterocutaneous Fistula Complicating Caesarean Section: A Case Report

“…Indeed, only 20 cases were reported in the literature over the last decade. [3,4] This unusual complication can follow surgeries such as caesarean sections (CS), hysterotomy and myomectomy. [5] Other causes that may result in this pathology include endometriosis, chronic infection, malignancies with local invasion to the adjacent organs, and the incomplete closure of wounds, particularly on the uterine wall.…”

“…[5] Other causes that may result in this pathology include endometriosis, chronic infection, malignancies with local invasion to the adjacent organs, and the incomplete closure of wounds, particularly on the uterine wall. [1,3] The clinical presentation is usually characterized by cyclical bleeding from the abnormal opening along the scar site on the abdomen. [3,6] A high index of suspicion is required to make a diagnosis, and this can be confirmed using imaging modalities such as hysterosalpingography (HSG), fistulogram, magnetic resonance imaging (MRI) of the pelvis, hysteroscopy, and computed tomography scan (CT scan) with intravenous contrast.…”