Post-LSCS uterocutaneous fistula-utility of magnetic resonance imaging in its diagnosis.

Mohd Ilyas,Obaid A Shah,Fahad Shafi,Insha Khan,Musaib Ahmad Dar,Tariq Gojwari

doi:10.4274/tjod.galenos.2019.29560

Abstract

The present report describes one of the rarest complications of cesarean section, uterocutaneous fistula, diagnosed on magnetic resonance imaging (MRI). A 37-year-old female with history of lower segment caesarean section (LSCS) four years previously presented with a chief symptom of discharge from the right end of a Pfannenstiel incision and on further evaluation was found to have uterocutaneous fistula arising from the LSCS scar to the right end of the abdominal incision. Uterocutaneous fistula is a rare delayed complication of LSCS and MRI plays a definitive role in the accurate diagnosis and delineation of the tract. The present case highlights that although rare, uterocutaneous fistulae must be kept in mind in patients presenting with discharge from the abdominal incision site and MRI evaluation should be performed in such cases for appropriate delineation of the tract.

Highlights

Uterine fistulae usually occur between the uterus and bowel or bladder with uterocutaneous forming the rarest variety of uterine fistulae
During the era of classic cesarean section, a number of cases of uterocutaneous fistula were reported but with the advent of lower segment caesarean section (LSCS), the frequency has decreased to a large extent
Most uterocutaneous fistulae owe their origin to infections complicating uterine or abdominal scars

Summary

Introduction

Uterine fistulae usually occur between the uterus and bowel or bladder (uterocolic or uterovesical) with uterocutaneous forming the rarest variety of uterine fistulae. The fistulae occur due to postoperative injuries or infections, use of drains, and incomplete closure of incision[1]. Uterocutaneous fistulae, being a rare condition, need appropriate diagnosis for which magnetic resonance imaging (MRI) plays the most important role, thereby helping in the proper delineation of the tract to guide the appropriate management[2]. The most common cause of uterocutaneous fistula is incomplete closure of the cesarean section wound. Earlier diagnosis can be made using fluoroscopic or cross-sectional modalities[3]. Ilyas et al Uterocutaneous fistula case of uterocutaneous fistula, which occurred 4 years after a caesarean section and was diagnosed using MRI

Case Report

Discussion

Authorship Contributions