Uterocutaneous Fistula after a C-Section in a Patient with Second Trimester Fetal Demise and Chorioamnionitis

Abstract

Uterocutaneous fistulae are very rare entities with only about 120 cases reported in the literature. They are mostly described after a C-section or other pelvic surgery. We hereby describe a uterocutaneous fistula in a 41-year-old patient 5 months after a C-section because of a chorioamnionitis and a 22-week fetal demise. One month after the C-section, she underwent a diagnostic hysteroscopy to exclude postoperative intrauterine adhesions. Afterwards, she complained of pelvic pain, persistent metrorrhagia, and significant weight loss during 2 months. She consulted the emergency unit several times, and lastly endometritis was diagnosed. She was treated with antibiotic therapy for 7 days, without significant clinical improvement. She presented at our institution 48 hours after a carbuncle had appeared in her right iliac fossa. A uterocutaneous fistula was diagnosed on the CT scan. The patient received IV antibiotic therapy and underwent a total hysterectomy with bilateral salpingectomy by laparotomy, as she did not want a conservative surgery. The clinical postoperative evolution was favorable. Symptoms of UCF can be very unspecific. To avoid medical wandering and improve the patient’s care, UCF should be in the differential diagnostic of abdominal pain after a pelvic surgery. Moreover, in patients with previous C-section and infectious perioperative status, the risk of PID or pelvic abscess must be careful evaluated before intrauterine diagnostic or therapeutic procedures.

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

“…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 5 …”

“…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. 5 Spontaneous closure of vesicovaginal 6 and enterocutaneous 7 fistulae is known and we acknowledge that there is a possibility that the uterocutaneous tract described herein may have healed naturally even without intervention.…”

Utero-cutaneous fistula. Review

“…Tratamentul chirurgical tradițional pentru FUC cuprinde excizia deschisă [42,43,44,46,47] sau laparoscopică [19] a tractului fistulos, cu toate acestea au fost raportate și strategii mai radicale, cum ar fi histerectomia [37,46]. Din 1958, când a fost publicat primul raport de caz despre FUC, până în 2007, rezecție chirurgicală completă, inclusiv histerectomia, a fost stabilită ca singura metodă curativă [2,39].…”

Utero-cutaneous fistula following caesarean section

“…Utero-cutaneous fistulae are so rare that only 120 cases are reported in the literature 1. Diagnosis can be achieved with MR fistulogram and prompt surgical excision of tract, repair of defect and omentoplasty will give excellent results postprocedure.…”