Uterocutaneous fistula following classical caesarean delivery for placenta percreta with intentional retention of the placenta

Athanasias, P.; Krishna, Archana; Karoshi, Mahantesh; Moore, Jessica; Chandraharan, Edwin

doi:10.3109/01443615.2013.825583

Cited by 11 publications

(8 citation statements)

References 7 publications

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“…17 Even rare complications such as a utero-cutaneous fistula have been reported with IRP. 18 Arterial embolization should not be performed routinely as rapid necrosis of trophoblastic tissue may predispose to sepsis and secondary haemorrhage. In cases of secondary postpartum haemorrhage during the follow-up of an IRP, an emergency embolization can be performed prior to hysterectomy, if deemed appropriate.…”

Section: Conservative Techniquesmentioning

confidence: 99%

Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure

Carrillo

Chandraharan

2019

Womens Health (Lond Engl)

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Abnormal invasion of placenta or placenta accreta spectrum disorders refer to the penetration of the trophoblastic tissue through the decidua basalis into the underlying uterine myometrium, the uterine serosa or even beyond, extending to pelvic organs. It is classified depending on the degree of invasion into placenta accreta (invasion <50% of the myometrium), increta (invasion >50% of the myometrium) and percreta (invading the serosa and adjacent pelvic organs). Clinical diagnosis is made intra-operatively; however, the confirmative diagnosis can only be made after a histopathological examination. The incidence of abnormal invasion of placenta has increased worldwide, mostly as a consequence of the rise in caesarean section rates, from 1 in 2500 pregnancies to 1 in 500 pregnancies. The importance of the disease is due to the increased maternal and foetal morbidity and mortality. Foetal implications are mainly due to iatrogenic prematurity, while maternal implications are mostly the increased risk of obstetric haemorrhage and surgical complications. The average blood loss is 3000–5000 mL, and up to 90% of the patients require a blood transfusion. An accurate and timely antenatal diagnosis is essential to improve outcomes. The traditional management of abnormal invasion of placenta has been a peripartum hysterectomy; however, the increased incidence and the short- and long-term consequences of a radical approach have led to the development of more conservative techniques, such as the intentional retention of the placenta, partial myometrial excision and the ‘Triple P procedure’. Irrespective of the surgical technique of choice, women with a high suspicion or confirmed abnormally invasive placenta should be managed in a specialist centre with surgical expertise with a multi-disciplinary team who is experienced in managing these complex cases with an immediate availability of blood products, interventional radiology service, an intensive care unit and a neonatal intensive care unit to optimize the outcomes.

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Section: Conservative Techniquesmentioning

confidence: 99%

Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure

Carrillo

Chandraharan

2019

Womens Health (Lond Engl)

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“…After 2008, medical treatment solely or combined to surgical treatment for young women who has a strongly desire fertility preserving were being reported [ 3 9 ]. In these recent reports, medical treatment with GnRH agonist might atrophied fistula epithelium and spontaneous closure was achieved [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, uterocutaneous fistula which is a pathologic communication between adherent uterus and skin surface is a rarely reported condition. The etiologies of uterocutaneous fistula are mostly iatrogenic, such as septic abortion probably after uterine perforation [ 1 ], previous uterine surgery including cesarean section [ 2 ], incomplete closure of incision site and incomplete placental removal especially with abnormally invasive placental implantation [ 3 ]. Owing to paucity of cases, there is no standard diagnostic and management strategies.…”

Section: Introductionmentioning

confidence: 99%

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

Min

Lee

et al. 2018

Obstet Gynecol Sci

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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.

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“…Many possible causes may predispose women to such extremely rare condition. Most of the reported cases of utero‐cutaneous fistula were diagnosed following surgical intervention such as Caesarean section delivery, complicating abortion especially with the presence of foreign bodies or foetal remnants in the uterine cavity, or incomplete placental removal …”

mentioning

confidence: 99%

“…It revealed a fistulous tract between the uterine cavity and surface of the skin at the LSCS scar. Magnetic resonance imaging of the pelvis was important to search for any predisposing factors as remnant of conception or foreign body . It has shown that the fistulas tract passing from the uterine cavity coursing at the lower edge of anterior subserosal fibroid into the skin surface in the middle of the LSCS scar.…”

mentioning

confidence: 99%

Utero‐cutaneous fistula following Caesarean section

Hefny

Nambiar²,

Jagdish³

et al. 2017

ANZ Journal of Surgery

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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.

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Uterocutaneous fistula following classical caesarean delivery for placenta percreta with intentional retention of the placenta

Cited by 11 publications

References 7 publications

Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure

Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure

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

Utero‐cutaneous fistula following Caesarean section

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