Successful Management of Uterocutaneous Fistula After Cesarean Delivery: A Case Report

Abstract

Background: We have, herein, presented a case of an uterocutaneous fistula after cesarian delivery. Case Presentation: A 24-years old female, gravida 3 para 3 with 2 living children, who underwent an emergency cesarean section about one month before the term due to preterm labor at Hamedan, was diagnosed with uterocutaneous fistula. Her medical history included 2 previous term cesarean section deliveries. She reported having fever and chills three weeks after the cesarian delivery. She also developed nausea, vomiting, and epigastric pain. Abdominal examination revealed a 30×40mm, firm, and tender mass on the right side of the cesarian section suture without any discharge. She was admitted with metritis as a primary diagnosis at N.H.F hospital. The performed transvaginal ultrasonography reported a hetero-echo mass with a diameter of 38×30×37mm with several echogenic foci and cystic components in the right ovary. After that, an abdominopelvic CT scan was done, and a 30×40mm mass in the right ovary with non-homogeneous due to collection and abnormal density with local hematoma at the site of the previous cesarian section was reported. Due to suspicion of lesion, the surgery was performed with the diagnosis of fascia opening and right Tubo-ovarian abscess and the infectious discharge of the right ovary. Right salpingo-oophorectomy surgery was performed. She was admitted again with the complaint of infectious discharge from the right side of the suture and erythema for one month. She also developed generalized abdominal pain. The patient was, thus, diagnosed with a uterocutaneous fistula and was admitted to the center. She became a trans-abdominal hysterectomy candidate and underwent surgery. Conclusion: One of the important risk factors for the fistula to be formed is an abscess. A few cases have been reported of post-cesarean uterocutaneous fistula in the literature. Surgical treatment associated with medical therapy can be effective in women with multiple cesarian sections. Any infected dehiscence must be radically operated.