Post-LSCS uterocutaneous fistula-utility of magnetic resonance imaging in its diagnosis

Abstract

The present report describes one of the rarest complications of cesarean section, uterocutaneous fistula, diagnosed on magnetic resonance imaging (MRI). A 37-year-old female with history of lower segment caesarean section (LSCS) four years previously presented with a chief symptom of discharge from the right end of a Pfannenstiel incision and on further evaluation was found to have uterocutaneous fistula arising from the LSCS scar to the right end of the abdominal incision. Uterocutaneous fistula is a rare delayed complication of LSCS and MRI plays a definitive role in the accurate diagnosis and delineation of the tract. The present case highlights that although rare, uterocutaneous fistulae must be kept in mind in patients presenting with discharge from the abdominal incision site and MRI evaluation should be performed in such cases for appropriate delineation of the tract.

Diagnosis and Methods of Repair for a Uteroperitoneal Fistula (UPF) Formed After Gynecological Surgeries

“…Regarding the diagnosis of UPFs, fistulograms, hysterosalpingography, and methylene blue tests can facilitate the diagnosis of UCFs. Magnetic resonance imaging and hysteroscopy are alternative methods for a definitive diagnosis in cases with a high suspicion of UCFs [ 10 ]. Assuming that the pathophysiology of UPFs is similar to that of UCFs and vesicouterine fistulas (VUFs), gonadotrophin-releasing agonists may serve as conservative therapy for UCFs; however, spontaneous healing is observed in only 50% (2/4) of the cases, and surgery is ultimately needed in the remainder, especially in cases where infertility treatment is desired [ 1 ].…”

Utero-cutaneous fistula. Review

“…Tomografia computerizată cu contrast intravenos și IRM reprezintă cele mai utile metode pentru identificarea cu precizie a tractului fistulos [1,41]. Vizualizarea tomografică permite delimitarea corectă a tractului după injectarea agentului de contrast prin orificiul extern a fistulei și permeabilitatea lui, însă rezoluția a scanărilor TC este mai mică în comparație cu IRM [1, 25,41].…”

“…Imagistica prin rezonanță magnetică oferă o bună rezoluție a țesuturilor moi, evită radiațiile, permite detectarea cu precizie a tractului fistulos și a relației sale cu viscerele adiacente [1,41]. La fel este posibilă evaluarea altor organe pelviene cu rezoluție spațială mai mare [1].…”