Shephard Steven Neil, Lengmang Sunday Jenner
Evangel VVF Center, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, Nigeria.
Case Rep Womens Health. 2015 Aug 24;8:4-5. doi: 10.1016/j.crwh.2015.08.002. eCollection 2015 Oct.
Uterocutaneous fistula is exceedingly rare, and uniformly follows some type of operative procedure. In this case, a young woman underwent a cesarean delivery at an outlying clinic in rural Nigeria, following which she developed amenorrhea and cyclic pelvic pain. In attempts to resolve her condition, a second laparotomy was performed at the same medical center. She presented to us 2 weeks later, at which time an opening was present at the healing laparotomy scar, severe vaginal scarring and cervical stenosis were present, and marked hematometra was seen on ultrasound. Following a procedure to open her cervix, she began menstruating through a fistulous tract in her abdomen, which we subsequently excised and closed with no further problems for the patient. This case highlights the challenge in developing countries of surgical complications resulting from a lack of appropriately trained physicians in rural medical centers. We suggest that focus on excellent training of our young physicians and the creation of incentives to place and keep fully qualified physicians in such hospitals will improve this situation.
子宫皮肤瘘极为罕见，且均继发于某种手术操作之后。在本病例中，一名年轻女性在尼日利亚农村的一家偏远诊所接受了剖宫产，术后出现闭经和周期性盆腔疼痛。为了缓解她的病情，在同一家医疗中心进行了第二次剖腹手术。两周后她前来就诊，此时剖腹手术切口愈合处有一个开口，存在严重的阴道瘢痕和宫颈狭窄，超声检查可见明显的子宫积血。在进行了扩宫颈手术后，她开始通过腹部的瘘管来月经，随后我们切除了瘘管并进行缝合，患者未再出现其他问题。该病例凸显了在发展中国家农村医疗中心因缺乏训练有素的医生而导致手术并发症的挑战。我们建议，专注于对年轻医生进行优质培训，并设立激励机制，以使合格医生愿意前往并留在这类医院，将改善这种状况。
