Utero‐cutaneous fistula following Caesarean section

Abstract

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.

Utero-cutaneous fistula after caesarean section delivery: diagnosis and management of a rare complication

“…Utero-cutaneous fistula is an extremely rare condition that should be considered when, after caesarean section delivery [1,2] signs of skin inflammation and/or infection persist. The literature provides only a few cases [3][4][5][6][7][8][9][10][11] . Utero-cutaneous fistula consists of an abnormal communication between 2 structures: the anterior wall of the uterus and the abdominal wall.…”

“…The causes include multiple caesarean sections, incomplete hysterorrhaphy [17], miscarriages, uterine cavity revision, retention of placental material after delivery, use of drains, post-operative infections, or injuries [2][3][4][5][6][7][8][9]18]. Other documented causes of this rare occurrence are intra-uterine devices and endometriosis -one of the most frequent causes of pelvic chronic pain [19][20][21][22].…”