Silva Cátia, Monteiro Cristina, Barbosa Fernando, Cunha Inês, Coutada Rosália, Carvalho Agostinho
Gynecological Department, Coimbra Hospital and University Centre, 3000-075 Coimbra, Portugal.
General Surgery Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal.
J Clin Med. 2024 Jan 29;13(3):783. doi: 10.3390/jcm13030783.
Postmenopausal abnormal uterine bleeding is a common clinical problem addressed in gynaecological practice and should prompt clinical investigation due to the significant prevalence of malignant and premalignant lesions of the endometrium in this age group. Nevertheless, other causes should be considered, since its diagnostic and therapeutic management may differ considerably. Here, we present a case of a colouterine fistula due to chronic diverticulitis presenting with postmenopausal abnormal uterine bleeding. This is an infrequent occurrence and is caused by the rupture of a diverticular abscess into the uterine wall, resulting in an inflammatory adhesion of the colon and uterus, with necrosis and subsequent fistula formation. The clinical presentation is variable and may include abdominal pain, gastrointestinal tract symptoms, vaginal discharge, and abnormal uterine bleeding. The laboratory and imaging techniques may be not completely conclusive and definitive diagnosis can be made intraoperatively. There are different treatment options, with en bloc resection and primary anastomosis being used most often, allowing complete treatment. The prognosis for a colouterine fistula secondary to diverticulitis is excellent after surgery. This case highlights the importance of clinical suspicion of an unusual cause of uterine bleeding and an effective and multidisciplinary approach that allowed complete surgical treatment and patient recovery.
绝经后异常子宫出血是妇科临床实践中常见的问题，鉴于该年龄组子宫内膜恶性和癌前病变的显著患病率，应促使进行临床调查。然而，由于其诊断和治疗管理可能有很大差异，其他病因也应予以考虑。在此，我们报告一例因慢性憩室炎导致结肠子宫瘘并表现为绝经后异常子宫出血的病例。这种情况并不常见，是由憩室脓肿破裂进入子宫壁所致，导致结肠与子宫发生炎性粘连，伴有坏死并随后形成瘘管。临床表现多样，可能包括腹痛、胃肠道症状、阴道分泌物及异常子宫出血。实验室检查和影像学技术可能并不完全具有决定性，术中可作出明确诊断。有不同的治疗选择，最常采用整块切除和一期吻合术，可实现彻底治疗。憩室炎继发结肠子宫瘘手术后的预后良好。该病例突出了临床怀疑子宫出血异常原因的重要性以及采用有效多学科方法实现彻底手术治疗和患者康复的重要性。
