Umbilical and Juxtaumbilical Chronic Discharging Sinus as a Delayed Complication of Caesarean Section: A Case Series

Abstract

Cutaneous or uterocutaneous sinus or fistula following caesarean section is a rare complication that can occur after the primary wound has healed. Only a few cases have been reported where a fistula or sinus tract forms after a caesarean section. These tracts can communicate externally through the scar line or the skin near the umbilicus (juxtaumbilical) and internally to the uterine scar or an unhealthy abnormal cavity. It is a delayed complication that presents with discharge from the skin opening and can be diagnosed using imaging techniques such as Ultrasonography (USG), Magnetic Resonance Imaging (MRI), Fistulogram, or Sinogram. These tracts often seek weak areas to establish external or internal connections with other organs. The management of these abnormal tracts can vary from conservative approaches to surgical excision. Herein, the authors presented a series of three cases of cutaneous and uterocutaneous fistula following caesarean section. In case 1, a 19-year-old female patient presented with a discharging sinus from the umbilicus, which was found to be a sinus tract communicating inside the abdominal wall to the external skin on imaging. The patient underwent surgery, which involved excision of the sinus tract and necrotic debridement. Two similar cases (cases 2 and 3) were infra and paraumbilical regions that presented with chronic discharges in the infra and para umbilical region following Lower Segment Caesarean Section (LSCS) delivery. Both cases were diagnosed with cutaneous sinus tracts in the juxtaumbilical region using USG and other imaging modalities. They were managed conservatively with appropriate antibiotics and achieved complete healing without any residual infection during follow-up.