Uterocutaneous fistula following B-Lynch suture for primary postpartum haemorrhage

Abstract

A 30-year-old woman, who had undergone emergency lower segment caesarean section (LSCS) for failed induction 2 months back, presented with a fistulous opening along with discharge from her previous incision scar. She had developed a massive primary postpartum haemorrhage at the time of LSCS 2 months back, which was managed with B-Lynch suture and vessel ligation. Fistulogram revealed a connection between the uterus and the skin. The diagnosis was confirmed by a contrast-enhanced CT scan. Patient was subjected to laparotomy. She was found to have an extensive necrosis of the anterior uterine wall. Total abdominal hysterectomy was done to avoid the risk of sepsis and haemorrhage. Postoperative period was uneventful. Histopathological examination confirmed the necrosis of the uterine wall. This case describes an extremely rare occurrence of uterocutaneous fistula as a result of uterine infarction following the application of B-Lynch suture for primary postpartum haemorrhage.

Uterocutaneous Fistula Secondary to an Uncomplicated Repetitive Cesarean Section

“…Our case includes two of the reported risk factors: repetitive C/S and wound infection in the early postoperative period. Although uterocutaneous fistulas are reported to occur at least 2 months after surgery [8,9], in this case, symptoms appeared as early as 1 month after the last C/S, with no additional predisposing factors found.…”

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) .…”

Post cesarean uterocutaneous fistula with successful repair and successful outcome: A case report

“…Most of the reported cases of uterocutaneous fistula were found following surgical intervention such as cesarean delivery or treatment for miscarriages. Thakur et al reported a 30-yearold lady, who developed uterocutaneous fistula after undergoing emergency lower segment caesarean section for failed induction 2 months back, and developed a massive primary postpartum hemorrhage at the time of cesarean section which was managed with B-Lynch suture and vessel ligation and Limp et al reported a 33 year-old lady who had an emergency cesarean section for retained second twin which was complicated by utero-cutaneous fistula due to red degeneration of intramural fibroids [1,3]. In one recent case series by Rezaei et al there was co-existence of uterocutaneous fistula and vesico-cutaneous fistula ("twin fistula") in a multiparous lady with two previous cesarean sections [9].…”

“…A fistula may be defined as an abnormal communication between two epithelium-lined surfaces [1]. Most uterine fistulae are between the uterus and the bowel or bladder (uterocolonic or uterovesical) due to postoperative injuries or infectious conditions [2].…”

“…An uterocutaneous fistula (communication between uterus and skin) is a rare condition, and there are only a few reports in this regard in the existing literature of its occurrence following cesarean section. Previous reports following cesarean section are associated with red degeneration of intramural fibroids, B-lynch sutures or multiple surgeries or insertion of drains or multi-associations [1,[3][4][5][6]. It has also been reported following criminal abortion [7].…”