Uterocutaneous Fistula Secondary to an Uncomplicated Repetitive Cesarean Section

Case Presentation

A 34-year-old patient who had undergone cesarean section (C/S) one week ago was admitted to our institution with a complaint of serous drainage from her incision. Her medical history was uneventful except for 3 previous C/S surgeries. She had her last operation at another institution with no complications, according to her medical records. We hospitalized the patient with a diagnosis of wound infection and administered an antibiotic regimen consisting of cephalosporin and metronidazole for ten days. After this treatment, we were able to discharge the patient without any complaints.

However, one month after discharge, she was readmitted complaining of sero-hemorrhagic drainage from a pinpoint on her scar. The initial examination raised suspicion of utero-cutaneous fistula. Her physical and laboratory findings were unremarkable. An attempt to perform fistulography with a probe inserted into the fistula duct failed due to the impossibility of guiding the catheter properly. Therefore, we scheduled a computed tomography scan, which eventually confirmed the clinical diagnosis ([Fig. 1]). After discussing the possible treatment modalities including hysterectomy, the patient opted for a uterus-preserving procedure. We then performed an explorative laparotomy, fistulectomy, and metroplasty ([Fig. 2]). The patient was discharged four days after surgery with a prophylactic antibiotic regimen. At a follow-up visit two months later, she had no complaints.

Fig. 1 Abdominal computed tomography showing the uterocutaneous fistula (arrows).

Fig. 2 Intraoperative picture of the uterus after excision of the fistula tract.

Publication History

Article published online:
14 September 2022

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