Hasan Jinan Nori, Musa Dildar Haji, Mohammed Ayad Ahmad
Duhok polytechnic University, Kurdistan Region, Iraq.
Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
Int J Surg Case Rep. 2021 Dec;89:106621. doi: 10.1016/j.ijscr.2021.106621. Epub 2021 Nov 19.
Fistula is an abnormal tract communicating two epithelial surfaces, uterocutaneous fistula is an extremely rare. The classical presentation is cyclical bleeding from an abnormal opening in the scar of previous cesarean section.
A 28 year-old was presented 6 months after cesarean section with history of severe pain and blood discharge during menstruation from the previous transverse supra-pubic scar. The patient had history of previous 2 cesarean sections. Abdominal examination revealed a localized tenderness at site of previous operation scar with 1*1 cm opening at the central part of the scar which was discharging blood during pressure over the lower abdomen. There was no urine discharge from the scar. Vaginal examination by the speculum was normal.
Endometriosis was suspected and the patient received medical treatment with little improvement. Later, surgical intervention was done, the scar was excised with an abnormal fistulous tract connecting endometrial cavity at the site of the previous scar was found. Complete excision of the tract was done and the uterus was re-sutured using a slowly-absorbable suture material. The patient had no complications with regular cycles.
Uterocutaneous fistula is rare and usually follow cesarean section, suturing the uterus with non-absorbable suture material is reported in this case to be one of the underlying causes, other causes include infection, necrosis, foreign bodies, or malignancy. The fistula tract must be defined and any associated infection controlled, complete resection of the fistulous tract and suturing the uterus with absorbable suture material is required.
瘘管是连接两个上皮表面的异常通道，子宫皮肤瘘极为罕见。典型表现为既往剖宫产瘢痕处异常开口出现周期性出血。
一名28岁女性在剖宫产术后6个月就诊，自述既往耻骨上横切口瘢痕处月经期间有剧痛和流血史。该患者既往有2次剖宫产史。腹部检查发现既往手术瘢痕处有局限性压痛，瘢痕中央有一个1×1厘米的开口，在下腹部施压时会流血。瘢痕处无尿液流出。阴道窥器检查正常。
怀疑为子宫内膜异位症，患者接受药物治疗但改善甚微。随后进行了手术干预，切除瘢痕后发现一条异常瘘管连接既往瘢痕处的子宫内膜腔。完整切除瘘管，并用可缓慢吸收的缝合材料对子宫进行了重新缝合。患者月经周期正常，无并发症。
子宫皮肤瘘罕见，通常发生于剖宫产术后，本病例报告显示用不可吸收缝合材料缝合子宫是潜在原因之一，其他原因包括感染、坏死、异物或恶性肿瘤。必须明确瘘管并控制任何相关感染，需要完整切除瘘管并用可吸收缝合材料缝合子宫。
