Thakur Monika, Rathore Sandeep S, Jindal Aditi, Mahajan Kunal
Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India.
Department of Interventional Cardiology, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, India.
BMJ Case Rep. 2018 Jan 5;2018:bcr-2017-223518. doi: 10.1136/bcr-2017-223518.
A 30-year-old woman, who had undergone emergency lower segment caesarean section (LSCS) for failed induction 2 months back, presented with a fistulous opening along with discharge from her previous incision scar. She had developed a massive primary postpartum haemorrhage at the time of LSCS 2 months back, which was managed with B-Lynch suture and vessel ligation. Fistulogram revealed a connection between the uterus and the skin. The diagnosis was confirmed by a contrast-enhanced CT scan. Patient was subjected to laparotomy. She was found to have an extensive necrosis of the anterior uterine wall. Total abdominal hysterectomy was done to avoid the risk of sepsis and haemorrhage. Postoperative period was uneventful. Histopathological examination confirmed the necrosis of the uterine wall. This case describes an extremely rare occurrence of uterocutaneous fistula as a result of uterine infarction following the application of B-Lynch suture for primary postpartum haemorrhage.
一名30岁女性，两个月前因引产失败接受了急诊下段剖宫产术（LSCS），现出现先前切口瘢痕处有瘘口并伴有分泌物。两个月前进行LSCS时她发生了大量原发性产后出血，当时采用B-Lynch缝合术和血管结扎术进行处理。瘘管造影显示子宫与皮肤之间存在连通。增强CT扫描确诊了该诊断。患者接受了剖腹手术。发现她有广泛的子宫前壁坏死。为避免败血症和出血风险，进行了全腹子宫切除术。术后过程顺利。组织病理学检查证实了子宫壁坏死。本病例描述了一种极为罕见的情况，即应用B-Lynch缝合术治疗原发性产后出血后发生子宫梗死导致子宫皮肤瘘。
