Wernly Déborah, Besse Valérie, Huber Daniela
Department of Obstetrics and Gynecology, Sion's Hospital, Valais, Switzerland.
Department of Radiology, Sion's Hospital, Valais, Switzerland.
Case Rep Obstet Gynecol. 2021 Sep 10;2021:3255188. doi: 10.1155/2021/3255188. eCollection 2021.
Uterocutaneous fistulae are very rare entities with only about 120 cases reported in the literature. They are mostly described after a C-section or other pelvic surgery. We hereby describe a uterocutaneous fistula in a 41-year-old patient 5 months after a C-section because of a chorioamnionitis and a 22-week fetal demise. One month after the C-section, she underwent a diagnostic hysteroscopy to exclude postoperative intrauterine adhesions. Afterwards, she complained of pelvic pain, persistent metrorrhagia, and significant weight loss during 2 months. She consulted the emergency unit several times, and lastly endometritis was diagnosed. She was treated with antibiotic therapy for 7 days, without significant clinical improvement. She presented at our institution 48 hours after a carbuncle had appeared in her right iliac fossa. A uterocutaneous fistula was diagnosed on the CT scan. The patient received IV antibiotic therapy and underwent a total hysterectomy with bilateral salpingectomy by laparotomy, as she did not want a conservative surgery. The clinical postoperative evolution was favorable. Symptoms of UCF can be very unspecific. To avoid medical wandering and improve the patient's care, UCF should be in the differential diagnostic of abdominal pain after a pelvic surgery. Moreover, in patients with previous C-section and infectious perioperative status, the risk of PID or pelvic abscess must be careful evaluated before intrauterine diagnostic or therapeutic procedures.
子宫皮肤瘘是非常罕见的病症，文献中仅报道了约120例。它们大多在剖宫产或其他盆腔手术后被描述。在此，我们描述一例41岁患者在因绒毛膜羊膜炎和22周胎儿死亡行剖宫产术后5个月出现的子宫皮肤瘘。剖宫产术后1个月，她接受了诊断性宫腔镜检查以排除术后宫腔粘连。此后，她在2个月内出现盆腔疼痛、持续性子宫出血和显著体重减轻。她多次前往急诊科就诊，最终被诊断为子宫内膜炎。她接受了7天的抗生素治疗，但临床症状无明显改善。在她右髂窝出现痈48小时后，她来到我们机构就诊。CT扫描诊断为子宫皮肤瘘。由于患者不希望进行保守手术，她接受了静脉抗生素治疗，并通过剖腹术进行了全子宫切除术及双侧输卵管切除术。术后临床进展良好。子宫皮肤瘘的症状可能非常不具有特异性。为避免医疗延误并改善患者护理，在盆腔手术后腹痛的鉴别诊断中应考虑子宫皮肤瘘。此外，对于有剖宫产史且围手术期存在感染情况的患者，在进行宫内诊断或治疗操作前，必须仔细评估盆腔炎或盆腔脓肿的风险。
