Laparoscopic Repair of a Post-myomectomy Uterocutaneous Fistula in a Nulligravida: A Case Report

Abstract

Introduction: An abnormal passage connecting the skin and the uterus is the uterocutaneous fistula. It is rarely observed after a cesarean section or a gynecological surgery involving the uterus. The presence of an infection further complicates the management. In countries such as India where tuberculosis is highly prevalent, Mycobacterium tuberculosis should be ruled out. Case Presentation: A 29-year-old nulliparous woman who had undergone a laparotomy for removal of a large fibroid for primary infertility presented with complaints of abdominal pain and discharge from the scar site. These symptoms did not resolve with antibiotics and analgesics. An ultrasonography was performed and a fistulous tract extending up to the endometrium was revealed. She underwent a laparoscopic resection of the fistulous tract following which she was symptom free. Conclusion: One of the rarely observed complications following laparotomies and cesarean section is a uterocutaneous fistula. It is even rarer in women with no previous pregnancies. The management involves adhesiolysis and layer by layer closure of the uterus and abdomen wall after excising the tract. Most often a repeat laparotomy is performed to treat the condition, but in the current times it is well known that repeated open surgeries in the peritoneal cavity increase the chances of adhesions which can reduce the chances of pregnancies in nulliparous women. Hence, this article shows a successful outcome of laparoscopic uterocutaneous fistula repair.