Fistula after Fibroids: Minimally Invasive Solution for a Uterocutaneous Tract

Abstract

Study Objective

To demonstrate a surgical case of a uterocutaneous fistula after open myomectomy treated with total laparoscopic hysterectomy.

Design

A case report with surgical video.

Setting

A tertiary care center.

Patients or Participants

A 33-year-old G1P1 with abnormal uterine bleeding secondary to fibroids with history of one prior myomectomy.

Interventions

The patient previously underwent an abdominal myomectomy via Pfannenstiel incision during which 60 fibroids were removed. She developed a subcutaneous abscess 6-weeks post-operatively that was treated with antibiotics and an incision and drainage. The wound was then followed outpatient with packing and daily dressing changes. Despite the wound healing well, 14-weeks post-operatively the patient experienced bloody discharge from her incision coinciding with her menstrual cycle. She presented to the emergency room and imaging showed a uterocutaneous fistula.

Measurements and Primary Results

The patient opted for definitive surgical management. A total laparoscopic hysterectomy was performed without complication and colorectal surgery performed an excision of the lower midline fistula tract to the level of the fascia. The patient recovered well without complication and the incisional defect was closed one month post-operatively.

Conclusion

Uterocutaneous fistulas are extremely rare with few cases reported in the literature. They occur most commonly after open myomectomy or cesarean section and oftentimes after a subsequent infection. This pathology can be treated medically or surgically and surgical treatment can be conservative with repair of the uterus or definitive with hysterectomy. The existing case reports of hysterectomy for treatment have been performed with an open approach and, to our knowledge, this is the first report of laparoscopic hysterectomy for treatment of a uterocutaneous fistula.