Gurnita Adiguna Wibawa, Achmad Eppy Darmadi
Obstetrics and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Int Med Case Rep J. 2023 Nov 6;16:719-723. doi: 10.2147/IMCRJ.S425424. eCollection 2023.
Uterocolon fistula is one of the complications of intrauterine device (IUD) insertion. Not only may IUD materials cause perforation, but some other risk factors may contribute to its development including uterine abnormalities, thus IUD is contraindicated in patients with anatomical anomaly.
P3A1 woman, 50 years old with a history of IUD use for 16 years presented with complaints of fecal discharge from the vagina 8 months ago which worsened after IUD extraction. Physical examination revealed no abdominal tenderness. Speculum examination found feces in the cervical canal. CT scan examination showed multiple uterocolon fistulas and uterine didelphys. Diagnostic laparoscopy and hysteroscopy were carried out and found a recto-uterine fistula, then the patient was scheduled for colostomy and reanastomosis with the stapler method.
Diagnosis was very difficult to establish despite proper imaging modalities. The use of direct visual diagnostics (hysteroscopy and laparoscopy) can be a good alternative for the diagnosis of uterocolon fistula. To the best of our knowledge, this is the first case report on recto-uterine fistula in a patient with long-term use of IUD and uterine didelphys.
子宫结肠瘘是宫内节育器（IUD）置入的并发症之一。IUD材料不仅可能导致穿孔，其他一些风险因素也可能促使其发生，包括子宫异常，因此解剖结构异常的患者禁忌使用IUD。
一名50岁、孕3产1的女性，有16年IUD使用史，8个月前出现阴道排粪症状，取出IUD后症状加重。体格检查未发现腹部压痛。阴道窥器检查发现宫颈管内有粪便。CT扫描检查显示多处子宫结肠瘘和双子宫。进行了诊断性腹腔镜检查和宫腔镜检查，发现直肠子宫瘘，随后患者计划行结肠造口术并采用吻合器法进行再吻合。
尽管有合适的影像学检查方法，但诊断仍非常困难。直接视觉诊断方法（宫腔镜检查和腹腔镜检查）可作为诊断子宫结肠瘘的良好替代方法。据我们所知，这是首例关于长期使用IUD和双子宫患者发生直肠子宫瘘的病例报告。
