Uterocutaneous fistula as the primary presentation of a gynaecological malignancy

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

Uterocutaneous fistulae are very rare entities with only about 120 cases reported in the literature. They are mostly described after a C-section or other pelvic surgery. We hereby describe a uterocutaneous fistula in a 41-year-old patient 5 months after a C-section because of a chorioamnionitis and a 22-week fetal demise. One month after the C-section, she underwent a diagnostic hysteroscopy to exclude postoperative intrauterine adhesions. Afterwards, she complained of pelvic pain, persistent metrorrhagia, and significant weight loss during 2 months. She consulted the emergency unit several times, and lastly endometritis was diagnosed. She was treated with antibiotic therapy for 7 days, without significant clinical improvement. She presented at our institution 48 hours after a carbuncle had appeared in her right iliac fossa. A uterocutaneous fistula was diagnosed on the CT scan. The patient received IV antibiotic therapy and underwent a total hysterectomy with bilateral salpingectomy by laparotomy, as she did not want a conservative surgery. The clinical postoperative evolution was favorable. Symptoms of UCF can be very unspecific. To avoid medical wandering and improve the patient's care, UCF should be in the differential diagnostic of abdominal pain after a pelvic surgery. Moreover, in patients with previous C-section and infectious perioperative status, the risk of PID or pelvic abscess must be careful evaluated before intrauterine diagnostic or therapeutic procedures.

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

The present report describes one of the rarest complications of cesarean section, uterocutaneous fistula, diagnosed on magnetic resonance imaging (MRI). A 37-year-old female with history of lower segment caesarean section (LSCS) four years previously presented with a chief symptom of discharge from the right end of a Pfannenstiel incision and on further evaluation was found to have uterocutaneous fistula arising from the LSCS scar to the right end of the abdominal incision. Uterocutaneous fistula is a rare delayed complication of LSCS and MRI plays a definitive role in the accurate diagnosis and delineation of the tract. The present case highlights that although rare, uterocutaneous fistulae must be kept in mind in patients presenting with discharge from the abdominal incision site and MRI evaluation should be performed in such cases for appropriate delineation of the tract.