Total laparoscopic management of uterocutaneous fistulas: A case report and review of literature

Abstract

Uterocutaneous fistulae are rare fistulas of the female genitourinary tract. It mostly follows caesarean section and subsequent post-operative wound infection. Only a handful of cases have been published in the literature. Surgical excision is the definitive management in most cases. Laparoscopic management has been used by many authors and gives good results. A 30-year-old multigravida presented with symptoms typical of uterocutaneous fistula and confirmed by magnetic resonance imaging of the pelvis. On diagnostic laparoscopy, the tract was delineated by methylene blue dye both through the opening in the skin as well as through the cervix. The complete excision of fistulous tract was done laparoscopically along with omental interposition between the uterus and the abdominal wall at the site of the fistula. Histopathologic examination of the tract confirmed endometriotic tissues without any chronic inflammation, typical of uterocutaneous fistula. The patient had an uneventful recovery, was started on diet the following day and discharged the next day. There was minimal post-operative pain and helped in early ambulation. On follow-up at 12 months, the tract had completely healed and the patient was completely asymptomatic. Uterocutaneous fistula is a rare complication that follows wound infection or suboptimal wound closure following caesarean section. As compared to the traditional excision by laparotomy, laparoscopy not only aids in confirmation of the diagnosis but also helps in complete excision of the tract with good results.

Keywords

• laparoscopic excision
• uterocutaneous fistula
• complication