Successful medical management of uterocutaneous fistula

Yadav, Poonam; Gupta, Smriti; Singh, Pushpa; Tripathi, Suchita

doi:10.1016/j.ijgo.2013.09.024

Cited by 17 publications

(25 citation statements)

References 3 publications

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“…Medical, surgical or combined medical and surgical treatment have been tried [9][10][11][12][13]. Treatment depends on the age of the patient and the desire to retain fertility.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment depends on the age of the patient and the desire to retain fertility. There are case reports of successful medical management of uterocutaneous fistula with six months therapy of GnRH agonists [11,12]. The mechanisms of action of GnRH agonists in the management of fistula are not clear.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms of action of GnRH agonists in the management of fistula are not clear. However, cessation of menstruation, endometrial atrophy, and decreasing uterine size may cause cicatrization and contracture of the fistulous tract, leading to fibrosis and closure [11][12]. Patients should be reviewed after six months for failure of medical management because of limitations of prolonged treatment with GnRH [9].…”

Section: Discussionmentioning

confidence: 99%

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Abdominal menstruation: A dilemma for the gynecologist

Kassem¹,

Kumar²,

Kansal³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comAbdominal menstruation: A dilemma for the gynecologist Seema Singhal, Sunesh Kumar, Yamini Kansal, Deepika Gupta, Mohit Joshi ABSTRACT Introduction: Menstrual fistulae are rare. They have been reported after pelvic inflammatory disease, pelvic radiation therapy, trauma, pelvic surgery, endometriosis, tuberculosis, gossypiboma, Crohn's disease, sepsis, migration of intrauterine contraceptive device and other pelvic pathologies. We report two rare cases of menstrual fistula. Case Series: Case 1: A 27-year-old nulliparous female presented with complaint of cyclical bleeding from the abdomen since three years. There was previous history of hypomenorrhea and cyclical abdominal pain since menarche. There is history of laparotomy five years back and laparoscopy four years back in view of pelvic mass. Soon after she began to have blood mixed discharge from scar site which coincided with her menstruation. She was diagnosed to have a vertical fusion defect with communicating left hypoplastic horn and non-communicating right horn on imaging. Laparotomy with excision of fistula and removal of right hematosalpinx was done. Case 2: 25-year-old female presented with history of lower segment caesarean section (LSCS) and burst abdomen, underwent laparotomy and loop ileostomy. Thereafter patient developed cyclical bleeding from scar site. Laparotomy with excision of fistulous tract and closure of uterine rent was done. Conclusion: Clinical suspicion and imaging help to clinch the diagnosis. There is no recommended treatment modality. Surgery is the mainstay of management. Complete excision of fistulous tract is mandatory for good long-term outcomes.

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“…Medical, surgical or combined medical and surgical treatment have been tried [9][10][11][12][13]. Treatment depends on the age of the patient and the desire to retain fertility.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Abdominal menstruation: A dilemma for the gynecologist

Kassem¹,

Kumar²,

Kansal³

et al. 2017

IJCRI

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“…The decrease in the incidence of uteroabdominal fistula may reasonably be attributed to marked decrease in the frequency classical caesarean type of operation in modern obstetrics [6,7]. Jain et al reported uterocutaneous fistula following lower segment caesarean section [8]. Gupta et al reported uterocutaneous fistula which developed following septic abortion induced by laminaria tent insertion in the cervix [5].…”

Section: Case Reportmentioning

confidence: 99%

Case Report of Uterocutaneous Fistula

Vellanki¹

2015

J Women's Health Care

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Uterocutaneous fistula, although not exceptional, is a very rare clinical entity. It occurs most often after uterine or pelvic surgery. We report a case of Uterocutaneous fistula which was formed following lower segment caesarean section. MRI was helpful in the diagnosis and was treated successfully with hysterectomy. This report aims to remind practicing clinicians about this rare complication of caesarean section and discuss our experience with its management.

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“…Many possible causes may predispose women to such extremely rare condition. Most of the reported cases of utero‐cutaneous fistula were diagnosed following surgical intervention such as Caesarean section delivery, complicating abortion especially with the presence of foreign bodies or foetal remnants in the uterine cavity, or incomplete placental removal …”

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confidence: 99%

Utero‐cutaneous fistula following Caesarean section

Hefny

Nambiar²,

Jagdish³

et al. 2017

ANZ Journal of Surgery

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A 36-year-old lady had a lower segment Caesarean section (LSCS) performed 2 weeks earlier presented with fever and greenish discharge from the wound for 2 days. No foul smelling lochia was noticed. On examination, she was pale. A small opening was seen in the middle of the LSCS scar discharging pus. Her abdomen was soft and not tender. Blood investigation showed Hb 88 g/L, and white blood cell count 18.6 10 9 /L. Ultrasound scan of the abdomen revealed fluid collection measuring approximately 3 × 1 cm in the anterior abdominal wall adjacent to the surgical site.The wound was opened and pus was drained. Following 2 weeks of daily changing the dressing, secondary suture was performed. The patient continued to have yellowish discharge from the wound.Around 11 weeks following the Caesarean section, the patient noticed blood-stained discharge from the wound during menstruation. Hysterosalpingography has shown utero-cutaneous fistulous (Fig. 1). Magnetic resonance imaging of the pelvis has shown a linear tract of utero-cutaneous fistula extending from the uterine lumen, coursing at the lower edge of anterior subserosal fibroid into the skin surface in the middle of LSCS scar site (Fig. 2). The subserosal fibroid was 1.8 × 1.3 cm. Surgical excision of the fistula was performed. During the surgical procedure, methylene blue dye was introduced into the uterine cavity using uterine cannula. The dye was seen coming out from the skin opening. The fistulous tract was completely excised including the segment in the anterior uterine wall. The subserous fibroid was excised and the defect in the anterior uterine wall was closed in layers. Histopathological examination revealed a tract lined by intensely inflamed granulation tissue in keeping with fistula. The excised fibroid showed extensive necrotic tissue. Post-operative period was uneventful. The patient was discharged home and the wound healed completely.

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Successful medical management of uterocutaneous fistula

Cited by 17 publications

References 3 publications

Abdominal menstruation: A dilemma for the gynecologist

Abdominal menstruation: A dilemma for the gynecologist

Case Report of Uterocutaneous Fistula

Utero‐cutaneous fistula following Caesarean section

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