Dr. Nitin Shah, has done his under graduation and post-graduation from Seth. G.S.M.C and K.E.M. Hospital. At present, he is working as consultant gynaec laparoscopic surgeon. He is the director of Vardann Multispeciality Hospital, Poisar, Kandivali West, Mumbai. He is scientific secretary of A.F.G. and managing committee member of I.A.G.E. He is the holder of 10 world records for his laparoscopic surgeries. He is recipient of golden hand award. He has published the highest number of cover page laparoscopic photo articles in J.O.G.I. He has more than 50 publications both national and international to his credit. He has won various awards and prizes at many national and international conferences.
A uterocutaneous fistula is a rare clinical presentation that occurs following cesarean section or any other pelvic surgery. We describe a case of uterocutaneous fistula with successful surgical management. A 25-year woman was referred to our hospital with complaints of cyclical bleeding from lower segment cesarean section scar (LSCS scar). It was diagnosed as uterocutaneous fistula on ultrasonography and computed tomography. The fistula tract was excised. Histopathology report was suggestive of sinus tract due to tuberculous etiology. Patient was started on antituberculous treatment. Recovery was uneventful.
Keywords : Uterocutaneous fistula, Cesarean section, Laparoscopy
A 25-year-old P1L1 complained of cyclical oozing of blood from her cesarean scar since 3 months during menses. She had history of LSCS done 9 months back with no past history of tuberculosis. On abdominal examination, two pinpoint openings were seen at the scar site. On ultrasonography and CT scan, there was evidence of fluid collection anterior to the uterus which communicated with the skin by two linear tracts of size 2.6 9 0.35 cm and 2.4 9 0.36 cm (Fig. 1). On hysteroscopy, fluid was seen coming through the fistulous opening on the skin, and the other end of the opening was seen at the level of isthmus (Fig. 2). On laparoscopy, uterus was densely adherent to the anterior abdominal wall (Fig. 3). Adhesiolysis was done with harmonic and scissors. The opening of the tracts in the uterus was visualized by passing dilators through the fistulous openings from the skin and was excised (Fig. 4). Edges of the uterine tissue were trimmed and repaired with polyglactin no. 1 in two layers (Fig. 5). The LSCS scar with fistulous tracts was excised (Fig. 6). Histopathology of the sinus tracts was suggestive of tuberculous etiology. Patient was started on antituberculous treatment. Postoperative wound healed without any complications.
Author Contributions NS has operated this case, searched literature and done the final proof reading of this article; PC who has done fellowship in laparoscopy under Dr. Nitin Shah has written this article, done literature search and helped in proof reading this article; and VM who has done fellowship in laparoscopy under Dr. Nitin Shah has assisted this case, done literature search and helped in proof reading this article.
Conflict of interest We have no conflict of interest or financial interests for the article.
Informed consent We authors hereby declare that we have taken the informed consent from the patient.
