Uteroperitoneal fistula post-caesarean section—Uterine conservation through a combined medical and surgical approach

Abstract

Introduction:A uteroperitoneal fistula is a rare complication of caesarean section which can present as a recurrent pelvic hematoma. Case Report: We present a case of a primigravida who underwent an emergency caesarean section complicated by a recurrent bladder flap hematoma (BFH). This was initially managed with a laparoscopic approach followed by percutaneous drainage. Ultimately she required a laparotomy due to further hematoma recurrence at which point a uterine dehiscence was noted and repaired. Unfortunately the dehiscence recurred resulting in a uteroperitoneal fistula identified on magnetic resonance imaging (MRI). This was managed with a gonadotropin releasing hormone antagonist which resulted in closure of the fistulous tract with conservation of the uterus. Conclusion: This case illustrates the complexities of diagnosing and managing this rare complication and proposes that uterine conservation is possible through a combined surgical and medical approach.