Uterocutaneous fistula as the primary presentation of a gynaecological malignancy

Abstract

We report a case of high-grade gynaecological carcinoma presenting as a uterocutaneous fistula. A 59-year-old woman presented with a discharging abdominal wall wound. Imaging confirmed a large solid pelvic mass forming a sinus tract with the anterior abdominal wall. The tract tunnelled through a previous caesarean section scar. Biopsy indicated a high-grade gynaecological carcinoma, with features suggestive of endometrioid adenocarcinoma. The patient underwent two cycles of chemotherapy. Despite this, the mass increased in size and was complicated by abdominal wall wound breakdown. Chemotherapy was ceased. Surgical and palliative options are under consideration.

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

“…Complications of a C-section or curettage for septic abortion associated with uterine perforation account for most cases [ 2 , 3 ]. In 2018, Hardy and Leung described a fistula as the primary presentation of a high-grade endometrioid adenocarcinoma [ 8 ]. Risk factors include multiple abdominal surgeries, corporeal hysterotomy, and presence of a foreign body (18), use of drains, or incomplete closure of a uterine wound following a C-section.…”

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

“…Cases of post-partum hemorrhage wherein B-lynch sutures are placed have high risk of scar dehiscence, which may result in uterocutaneous fistula (6,7) . Other rare causes that may result in the formation of uterocutaneous fistula are patients with multiple abdominal myomectomies, history of hysterectomy, and as a primary presentation in underlying gynecologic malignancy such as endometrioid adenocarcinoma, which can predispose the weak cesarean scar to fistula formation (6,7,8) . The blood leakage from the incision site during menstruation has been described as pathognomonic of the uterocutaneous fistula (9) .…”