Introduction: Cutaneous gluteal vaginal fistula is a rare but significant postoperative complication which may present years after sacrospinous ligament fixation (SSLF) surgery There is limited data on the management of cutaneous vaginal fistula following SSLF.Case description: This case report describes a 77-yearold who presents twenty years after SSLF with cutaneous gluteal vaginal abscess and fistula. She underwent successful management with CT-guided percutaneous drainage of gluteal abscess and placement of guiding cutaneous vaginal catheter, laparoscopic pelvic wall dissection and evaluation, and transvaginal localization and removal of the infected permanent suture.Discussion: Multi-disciplinary approach should be considered in the treatment of chronic fistula status post SSLF, including interventional radiology, urogynecology, and minimally invasive gynecologic surgery.

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Endometrial implants have long been noticed to decidualize during pregnancies. They have been reported in a variety of locations in the pelvis and abdomen. These lesions are usually noted incidentally with no negative sequelae. This is not always the case and we present a case of massive hemorrhage from decidualized endometriotic lesions during a cesarean section.