Uterocutaneous fistula after pelviscopic myomectomy - successful diagnosis with hystero-salpingo contrast sonography and complete tract resection and medical treatment for fertility preservation in young woman: a case report

Abstract

A uterocutaneous fistula is rarely reported clinical condition after uterine procedures. Many diagnostic and management strategies are being suggested. In this case report, uterocutaneous fistula after pelviscopic myomectomy was diagnosed simply with hystero-salpingo contrast sonography and managed by surgical tract excision without hysterectomy and uterine wall dehiscence repair combined with medical treatment using gonadotropin-releasing hormone agonist succeeded to preserve fertility in young woman.

Uterocutaneous fistula after abdominal myomectomy: A case report

“…[5][6][7][8][9] Myomectomy is a common operation for symptomatic women with uterine fibroids who wish to preserve their reproductive potential, and to date, only three cases of uterocutaneous fistula have been reported after myomectomy. [10][11][12] The present patient underwent abdominal multiple myomectomies, with 31 myomas removed. The surgery was difficult, and incomplete closure of the uterine wound and the use of nonabsorbable sutures increased the risk of postoperative infection, which eventually caused the uterocutaneous fistula.…”

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

“…Our review suggests that two important factors may affect the success of medical management, namely the size of the UCF and the duration of treatment with GnRH analogues. Nonsurgical closure of the tract appears more likely to succeed if treatment prolonged for at least 6 months 4,5,8 and if the fistulous tract is 5 mm or less in diameter 4,5,9 (Table 1). The fistula dimensions in the cases reported by Seyhan, 4 Yadav, 5 and Min 9 successfully treated with GnRH alone were 2 mm, 5 mm, and 5 mm, respectively, while a 10 mm UCF 10 similarly treated required subsequent surgical intervention.…”

“…2 Pathogenesis of UCF is multifactorial but initial iatrogenic disruption of the integrity of the uterine wall, subcutaneous tissue, and skin, further compounded by subsequent infective necrosis are likely contributory factors. Typical pelvic surgical procedures associated with UCF include CS 1,2 and open myomectomy 7,9 as in both of these, a potential channel is created between the uterus and the abdominal skin. The mechanism of action of leuprolide in this case is unclear but we postulate that it produces endometrial atrophy, leading to contracture, fibrosis, and eventual closure of the fistulous tract.…”

“…Hitherto, only five cases of conservative therapy with GnRH analogs have been described in the literature, 4,5,8–10 of which three have reported success. Our review suggests that two important factors may affect the success of medical management, namely the size of the UCF and the duration of treatment with GnRH analogues.…”

“…Nonsurgical closure of the tract appears more likely to succeed if treatment prolonged for at least 6 months 4,5,8 and if the fistulous tract is 5 mm or less in diameter 4,5,9 (Table 1). The fistula dimensions in the cases reported by Seyhan, 4 Yadav, 5 and Min 9 successfully treated with GnRH alone were 2 mm, 5 mm, and 5 mm, respectively, while a 10 mm UCF 10 similarly treated required subsequent surgical intervention. Likewise, two of the three cases measuring 5 mm or less, were cured after receiving GnRH agonists for 6 months 4,5 .…”