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Coumary S, Galidevara I, Naga Daliya V, Ghose S. Utero-cutaneous fistula following caesarean section. BMJ Case Rep 2024; 17:e255901. [PMID: 38331447 PMCID: PMC10860007 DOI: 10.1136/bcr-2023-255901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
A multiparous woman in her 20s, presented to the clinic with bleeding from caesarean scar site. After clinical examination and radiological evaluation with ultrasound and MR fistulogram, the diagnosis was utero-cutaneous fistula. Complete resection of fistulous tract with uterine defect closure and supportive omental patch placement was done after an intraoperative demonstration of the utero-cutaneous fistula by injecting methylene blue dye. Utero-cutaneous fistula is a rare complication after caesarean section. Cyclical bleeding from an abnormal opening in previous caesarean scar site is the classical presentation of this condition.
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Affiliation(s)
- Senthil Coumary
- Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Indira Galidevara
- Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Venna Naga Daliya
- Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Seetesh Ghose
- Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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Okba M, Ibrahim S, Jaly AA, Govind A. Actinomycosis infection causing a utero-cutaneous fistula. J OBSTET GYNAECOL 2022; 42:2524-2526. [PMID: 35164640 DOI: 10.1080/01443615.2022.2029378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohamed Okba
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS, London, UK
| | - Shereen Ibrahim
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS, London, UK
| | - Alaa Alsadik Jaly
- Department of Radiology, North Middlesex University Hospital NHS, London, UK
| | - Abha Govind
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS, London, UK
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Cicinelli R, Cicinelli E, Crupano F, Vinciguerra M, Lamanna B, Vimercati A. A rare but troublesome complication of cesarean section: the uterocutaneous fistula. Report of two cases and review of literature. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The occurrence of a uterocutaneous fistula (UCF) as an uncommon and severe complication of caesarean section (CS). The aim of this study was to describe two cases of UCFs after CS and to discuss about symptoms, diagnosis and treatment.
Case presentation
Both women few days after CS had surgical site infection, fever and elevation of lab inflammation markers. bacterial culture of the wound drainage was positive for Escherichia Coli and Enterococcus Faecalis.
Conclusions
Fistula between uterine and skin is a rare condition but should be considered with signs of inflammation after cesarean section; 2D/3D ultrasound evaluation appears to be useful for diagnosis of UCFs when combined with CT fistulography and MRI in order to obtain early diagnosis and, consequently, a conservative surgery.
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Affiliation(s)
- Rossana Cicinelli
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Francesco Crupano
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Marina Vinciguerra
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Bruno Lamanna
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Antonella Vimercati
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
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Uterocutaneous fistula after cesarean section; Case report. Int J Surg Case Rep 2021; 89:106621. [PMID: 34847394 PMCID: PMC8639420 DOI: 10.1016/j.ijscr.2021.106621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Fistula is an abnormal tract communicating two epithelial surfaces, uterocutaneous fistula is an extremely rare. The classical presentation is cyclical bleeding from an abnormal opening in the scar of previous cesarean section. Case presentation A 28 year-old was presented 6 months after cesarean section with history of severe pain and blood discharge during menstruation from the previous transverse supra-pubic scar. The patient had history of previous 2 cesarean sections. Abdominal examination revealed a localized tenderness at site of previous operation scar with 1*1 cm opening at the central part of the scar which was discharging blood during pressure over the lower abdomen. There was no urine discharge from the scar. Vaginal examination by the speculum was normal. Clinical discussion Endometriosis was suspected and the patient received medical treatment with little improvement. Later, surgical intervention was done, the scar was excised with an abnormal fistulous tract connecting endometrial cavity at the site of the previous scar was found. Complete excision of the tract was done and the uterus was re-sutured using a slowly-absorbable suture material. The patient had no complications with regular cycles. Conclusion Uterocutaneous fistula is rare and usually follow cesarean section, suturing the uterus with non-absorbable suture material is reported in this case to be one of the underlying causes, other causes include infection, necrosis, foreign bodies, or malignancy. The fistula tract must be defined and any associated infection controlled, complete resection of the fistulous tract and suturing the uterus with absorbable suture material is required. Causes of uterocutaneous fistulas are numerous like iatrogenic, endometriosis, malignancy, etc. The classical presentation is cyclical bleeding from the scar of previous cesarean section. A combined medical and surgical approach may be required.
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Jindal A, Chaudhary H, Thakur M. Tubercular uterocutaneous fistula after caesarean section: A case report. Case Rep Womens Health 2018; 17:3-4. [PMID: 29594005 PMCID: PMC5869061 DOI: 10.1016/j.crwh.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/01/2018] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
A 29-year-old patient had undergone an elective lower-segment caesarean section (LSCS) five months previously at a district hospital. The operation and the immediate postoperative period were uneventful. After five months she presented back with a fistulous opening. A fistulogram revealed a connection between the uterus and the skin. Fistulous tract excision was planned. Intraoperatively there was communication between the skin and the uterine cavity, with extensive necrosis of the uterine wall. The patient gave her informed consent for excision of the fistulous tract and/or total abdominal hysterectomy. During surgery, it was deemed that there was no scope for excision, so the decision was made for a total abdominal hysterectomy. Histopathological examination confirmed tuberculosis and the patient responded well to anti-tubercular drugs. This case report describes a rare presentation of tubercular uterocutaneous fistula after caesarean section. Uterocutaneous fistula is a communication between the uterine cavity to the exterior. The cause of uterocutaneous fistula in our case was tuberculosis. Tuberculosis should be considered in wound not responding to standard medical management. Genital tuberculosis being paucibacillary, is difficult to diagnose. Uterocutaneous fistulas usually require surgical management. As in our case it resulted in hysterectomy in a young patient.
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Affiliation(s)
- Aditi Jindal
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Himanshu Chaudhary
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Monika Thakur
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
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Thakur M, Rathore SS, Jindal A, Mahajan K. Uterocutaneous fistula following B-Lynch suture for primary postpartum haemorrhage. BMJ Case Rep 2018; 2018:bcr-2017-223518. [PMID: 29305372 DOI: 10.1136/bcr-2017-223518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Monika Thakur
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Sandeep S Rathore
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Aditi Jindal
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Kunal Mahajan
- Department of Interventional Cardiology, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, India
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Chattot C, Aristizabal P, Bendifallah S, Daraï E. Uteroabdominal Wall Fistula After Cesarean Section in a Patient With Prior Colorectal Resection for Endometriosis: A Case Report and Systematic Review. J Minim Invasive Gynecol 2017; 24:1234-1238. [DOI: 10.1016/j.jmig.2017.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 01/24/2023]
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Maddah G, Fattahi AS, Rahnama A, Jamshidi ST. Uterocutaneous Fistula Following Cesarean Section: Successful Management of a Case. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:157-60. [PMID: 26989289 PMCID: PMC4764968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation - she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months' postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management.
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Affiliation(s)
- Ghodratollah Maddah
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Sadat Fattahi
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence: Asieh Sadat Fattahi, MD; Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Ahmadabad Ave., Postal Code: 99199-9176, Mashhad, Iran Tel: +98 9151163883 Fax: +98 51 38417452
| | - Ali Rahnama
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shirin Taraz Jamshidi
- Solid Tumor Treatment Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Shephard SN, Lengmang SJ. The path of least resistance: A case of cervical stenosis and uterocutaneous fistula. Case Rep Womens Health 2015; 8:4-5. [PMID: 29629311 PMCID: PMC5886003 DOI: 10.1016/j.crwh.2015.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 11/05/2022] Open
Abstract
Uterocutaneous fistula is exceedingly rare, and uniformly follows some type of operative procedure. In this case, a young woman underwent a cesarean delivery at an outlying clinic in rural Nigeria, following which she developed amenorrhea and cyclic pelvic pain. In attempts to resolve her condition, a second laparotomy was performed at the same medical center. She presented to us 2 weeks later, at which time an opening was present at the healing laparotomy scar, severe vaginal scarring and cervical stenosis were present, and marked hematometra was seen on ultrasound. Following a procedure to open her cervix, she began menstruating through a fistulous tract in her abdomen, which we subsequently excised and closed with no further problems for the patient. This case highlights the challenge in developing countries of surgical complications resulting from a lack of appropriately trained physicians in rural medical centers. We suggest that focus on excellent training of our young physicians and the creation of incentives to place and keep fully qualified physicians in such hospitals will improve this situation.
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Affiliation(s)
- Steven Neil Shephard
- Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria
| | - Sunday Jenner Lengmang
- Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria
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Tubocutaneous fistula. Case Rep Obstet Gynecol 2015; 2015:104360. [PMID: 25945270 PMCID: PMC4405214 DOI: 10.1155/2015/104360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/08/2015] [Accepted: 01/22/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Tubocutaneous fistula is a very rare condition; most cases described in the literature are secondary to endometriosis, tuberculosis, and complications of child birth and gynecological operations. Case Presentation. We report a case of 40-year-old woman who presented with tubocutaneous fistula secondary to pelvic inflammatory disease which was diagnosed in the setting of persistent discharging wound in the right groin. Conclusion. Tubocutaneous fistula is a rare condition. Salpingectomy and resection of fistulous tract is the treatment of choice as is treating the underlying cause. Early diagnosis and treatment of these patients are essential for avoiding long term complications.
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Athanasias P, Krishna A, Karoshi M, Moore J, Chandraharan E. Uterocutaneous fistula following classical caesarean delivery for placenta percreta with intentional retention of the placenta. J OBSTET GYNAECOL 2013; 33:906-7. [DOI: 10.3109/01443615.2013.825583] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lim PS, Shafiee MN, Ahmad S, Hashim Omar M. Utero-cutaneous fistula after caesarean section secondary to red degeneration of intramural fibroid. SEXUAL & REPRODUCTIVE HEALTHCARE 2012; 3:95-6. [PMID: 22578758 DOI: 10.1016/j.srhc.2012.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/13/2012] [Accepted: 03/02/2012] [Indexed: 11/28/2022]
Abstract
A 33 year-old woman had an emergency caesarean section for retained second twin which was complicated by utero-cutaneous fistula due to red degeneration of intramural fibroid. The utero-cutaneous communication was demonstrated by an examination under anaesthesia using dye test. She then underwent excision of the fistula tract and myomectomy. She recovered well following the surgery. This is the first case of utero-cutaneous fistula where the communication is between the endometrial cavity and skin lesion via a necrotic intramural fibroid following caesarean section. Fistulogram might fail to demonstrate the communication. In highly suspected case, other modalities of investigations could be utilised.
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Affiliation(s)
- Pei Shan Lim
- Department of O&G, Medical Faculty, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur Malaysia.
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Combined Conservative Surgical and Medical Treatment of a Uterocutaneous Fistula. J Minim Invasive Gynecol 2012; 19:244-7. [DOI: 10.1016/j.jmig.2011.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/12/2011] [Accepted: 10/21/2011] [Indexed: 11/19/2022]
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Baggish M, Bhati A. Uterocutaneous Fistula: A Complication of Ruptured Appendix and Crohn's Disease During Pregnancy. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2010.0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Baggish
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH
| | - Anant Bhati
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH
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Uterocutaneous fistula after surgical treatment of an incomplete abortion: methylene blue test to verify the diagnosis. Arch Gynecol Obstet 2008; 279:225-7. [PMID: 18506462 DOI: 10.1007/s00404-008-0683-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Accepted: 05/05/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Uterocutaneous fistula is an extremely rare clinical condition that can be seen after pelvic or uterine surgery. It can also complicate some obstetric procedures. CASE We report of an unusual case of an uterocutaneous fistula that developed in a multiparous woman after surgical evacuation of an incomplete first trimester septic abortion. The fistula tract was depicted on computed tomography, and to verify the diagnosis methylene blue was given through a transcervically introduced uterine catheter, and blue dye flow out through the external opening of fistula was observed. At laparatomy fistula tract was completely excised along with the enclosing omentum. Postoperative recovery and follow-up were uneventful. DISCUSSION Possible mechanisms of development of such a rare condition, and diagnostic and treatment options are discussed.
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Medical treatment of uterocutaneous fistula with gonadotropin-releasing hormone agonist administration. Obstet Gynecol 2008; 111:526-8. [PMID: 18239009 DOI: 10.1097/01.aog.0000281670.94265.5c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uterocutaneous fistula is a rare complication of uterine surgery. All published cases have been surgically treated with hysterectomy and excision of the fistulous tract. We report a case of uterocutaneous fistula that was successfully treated with gonadotropin-releasing hormone agonist administration. CASE A 25-year-old woman reported bloody discharge during her periods from a previous Pfannenstiel incision. A fistulous tract leading from the incision scar to the uterus was diagnosed. Leuprolide acetate depot was administered twice subcutaneously at a dose of 11.25 mg. The fistulous tract closed spontaneously, and the patient was symptom free thereafter. CONCLUSION Medical treatment with gonadotropin-releasing hormone agonists should be considered before resorting to surgery for treatment of uterocutaneous fistulae.
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