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Silva C, Monteiro C, Barbosa F, Cunha I, Coutada R, Carvalho A. Colouterine Fistula as a Rare Cause of Postmenopausal Abnormal Uterine Bleeding: A Case Report. J Clin Med 2024; 13:783. [PMID: 38337477 PMCID: PMC10856449 DOI: 10.3390/jcm13030783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Postmenopausal abnormal uterine bleeding is a common clinical problem addressed in gynaecological practice and should prompt clinical investigation due to the significant prevalence of malignant and premalignant lesions of the endometrium in this age group. Nevertheless, other causes should be considered, since its diagnostic and therapeutic management may differ considerably. Here, we present a case of a colouterine fistula due to chronic diverticulitis presenting with postmenopausal abnormal uterine bleeding. This is an infrequent occurrence and is caused by the rupture of a diverticular abscess into the uterine wall, resulting in an inflammatory adhesion of the colon and uterus, with necrosis and subsequent fistula formation. The clinical presentation is variable and may include abdominal pain, gastrointestinal tract symptoms, vaginal discharge, and abnormal uterine bleeding. The laboratory and imaging techniques may be not completely conclusive and definitive diagnosis can be made intraoperatively. There are different treatment options, with en bloc resection and primary anastomosis being used most often, allowing complete treatment. The prognosis for a colouterine fistula secondary to diverticulitis is excellent after surgery. This case highlights the importance of clinical suspicion of an unusual cause of uterine bleeding and an effective and multidisciplinary approach that allowed complete surgical treatment and patient recovery.
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Affiliation(s)
- Cátia Silva
- Gynecological Department, Coimbra Hospital and University Centre, 3000-075 Coimbra, Portugal
| | - Cristina Monteiro
- General Surgery Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (C.M.); (F.B.)
| | - Fernando Barbosa
- General Surgery Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (C.M.); (F.B.)
| | - Inês Cunha
- Gastroenterology Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal;
| | - Rosália Coutada
- Gynecological Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (R.C.); (A.C.)
| | - Agostinho Carvalho
- Gynecological Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (R.C.); (A.C.)
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Pontone S, Nardis PG, Eberspacher C, Mascagni D. A case report of a colouterine fistula treatment: when the patient chooses the steeplechase. Ann Coloproctol 2023; 39:366-370. [PMID: 34376024 PMCID: PMC10475798 DOI: 10.3393/ac.2021.00318.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022] Open
Abstract
Colouterine fistula is a rare disease that is primarily treated using surgical approaches. Although invasive surgery is controversial in terms of techniques and results, minimally invasive endoscopic treatments have not been widely described. However, because it is rare for these fistulas to close spontaneously, surgical treatment is often mandatory. Appropriate management of colouterine fistula is complicated, especially when the patient refuses surgery. In this case study, we provide the first description of a minimally invasive endoscopic treatment of an iatrogenic colouterine fistula using a self-expandable metallic stent after an over-the-scope clip malposition.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Pier Giorgio Nardis
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Eberspacher
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Mascagni
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Gündüz R, İçen MS. Uterocutaneous fistula: a rare complication after relaparotomy performed due to postpartum haemorrhage. J OBSTET GYNAECOL 2022; 42:3374-3375. [PMID: 35639871 DOI: 10.1080/01443615.2022.2081795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Reyhan Gündüz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Dicle University, Diyarbakır, Turkey
| | - Mehmet Sait İçen
- Faculty of Medicine, Department of Obstetrics and Gynecology, Dicle University, Diyarbakır, Turkey
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Colouterine and Jejunouterine Fistula Secondary to Chronic Diverticulitis. Case Rep Gastrointest Med 2021; 2021:5543505. [PMID: 33868734 PMCID: PMC8032511 DOI: 10.1155/2021/5543505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/02/2022] Open
Abstract
Fistulae between the colon or the small intestine and the uterus are extremely rare as the uterus is a thick, muscular organ. Here, we present the case of a 74-year-old female presenting to our surgical department because of fecal vaginal discharge for the past few months, which proved to be caused by a combined colouterine and jejunouterine fistula due to chronic diverticulitis. Total abdominal hysterectomy with bilateral oophorectomy with en bloc resection of part of the jejunum and the sigmoid colon and primary anastomoses were performed. This case represents an unusual type of diverticulitis complication and aims to point out the diagnostic and therapeutic issues of such a rare medical condition.
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Delara R, Cornella J, Young-Fadok T, Wasson M. Colouterine Fistula Presenting as Postmenopausal Endometritis. J Minim Invasive Gynecol 2019; 27:1234-1236. [PMID: 31786389 DOI: 10.1016/j.jmig.2019.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/06/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Ritchie Delara
- Department of Gynecologic Surgery (Drs. Delara, Cornella, and Wasson); Division of Colon and Rectal Surgery, Department of Surgery (Dr. Young-Fadok), Mayo Clinic Hospital, Phoenix, AZ..
| | - Jeffrey Cornella
- Department of Gynecologic Surgery (Drs. Delara, Cornella, and Wasson); Division of Colon and Rectal Surgery, Department of Surgery (Dr. Young-Fadok), Mayo Clinic Hospital, Phoenix, AZ
| | - Tonia Young-Fadok
- Department of Gynecologic Surgery (Drs. Delara, Cornella, and Wasson); Division of Colon and Rectal Surgery, Department of Surgery (Dr. Young-Fadok), Mayo Clinic Hospital, Phoenix, AZ
| | - Megan Wasson
- Department of Gynecologic Surgery (Drs. Delara, Cornella, and Wasson); Division of Colon and Rectal Surgery, Department of Surgery (Dr. Young-Fadok), Mayo Clinic Hospital, Phoenix, AZ
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Ilyas M, Khan I, Gojwari T, Dar MA, Shafi F, Shah OA. Post-LSCS uterocutaneous fistula-utility of magnetic resonance imaging in its diagnosis. Turk J Obstet Gynecol 2019; 16:133-135. [PMID: 31360589 PMCID: PMC6637778 DOI: 10.4274/tjod.galenos.2019.29560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/07/2019] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Mohd Ilyas
- Sher-I-Kashmir Institute of Medical Sciences, Department of Radiodiagnosis, Srinagar, India
| | - Insha Khan
- Sher-I-Kashmir Institute of Medical Sciences, Department of Obstetrics and Gynecology, Srinagar, India
| | - Tariq Gojwari
- Sher-I-Kashmir Institute of Medical Sciences, Department of Radiodiagnosis, Srinagar, India
| | - Musaib Ahmad Dar
- Sher-I-Kashmir Institute of Medical Sciences, Department of Radiodiagnosis, Srinagar, India
| | - Fahad Shafi
- Sher-I-Kashmir Institute of Medical Sciences, Department of Radiodiagnosis, Srinagar, India
| | - Obaid A Shah
- Sher-I-Kashmir Institute of Medical Sciences, Department of Radiodiagnosis, Srinagar, India
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Kotzev A, Tanchev L, Encheva L, Kovachev N, Betova T. Sigmoidouterine Fistula in Crohn's Disease: A First Case Report. Inflamm Bowel Dis 2019; 25:e65-e66. [PMID: 30445527 DOI: 10.1093/ibd/izy352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Andrey Kotzev
- Clinic of Gastroenterology, University Hospital "Alexandrovska," Sofia, Bulgaria
| | - Lachesar Tanchev
- Clinic of Obstetrics and Gynecology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Lora Encheva
- Obstetric Clinic, University Hospital "Dr. Georgi Stranski," Pleven, Bulgaria
| | - Nikolay Kovachev
- Clinic of Oncological Surgery, University Hospital "Dr. Georgi Stranski, Pleven, Bulgaria
| | - Tatyana Betova
- Department of General and Clinical Pathology, University Hospital "Dr. Georgi Stranski," Pleven, Bulgaria
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