title: Combined conservative surgical and medical treatment of a uterocutaneous fistula.
abstract: Uterocutaneous fistula is a rare complication that may follow cesarean section. Herein is described a rare case of uterocutaneous fistula. The patient, a 28-year-old woman with a history of American Society for Reproductive Medicine stage IV endometriosis (Douglas pouch obliteration), underwent a cesarean section at 25 weeks of gestation (twin pregnancy). Postoperatively, the patient returned to the emergency service because of the appearance of pus through the cesarean section abdominal scar, and was treated for a subcutaneous abscess. Because drainage continued, the presence of a uterocutaneous fistula was suspected. Magnetic resonance imaging confirmed this diagnosis. Hysteroscopy clearly revealed the uterine neck of the fistula tract. Leuprolide acetate (gonadotropin-releasing hormone agonist) deposit suspension was administered subcutaneously monthly for 6 months. Surgery via laparoscopy and laparotomy was performed. This combined medical and conservative surgical treatment was successful. At 6-month follow-up, hysteroscopy revealed a normal uterine cavity. We conclude that magnetic resonance imaging and hysteroscopy are helpful in diagnosis of uterocutaneous fistula. Conservative surgical treatment associated with medical therapy can be an efficient procedure in women who desire subsequent pregnancies.
authors.affiliation: Faculté de Médecine, Université Paris-Sud, Le Kremlin Bicêtre, Paris, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Thubert
authors.forename: Céline
authors.initials: C
authors.lastname: Denoiseux
authors.forename: Erika
authors.initials: E
authors.lastname: Faivre
authors.forename: Alix
authors.initials: A
authors.lastname: Naveau
authors.forename: Caroline
authors.initials: C
authors.lastname: Trichot
authors.forename: Xavier
authors.initials: X
authors.lastname: Deffieux
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003131:Combined Modality Therapy; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D007813:Laparotomy; D016729:Leuprolide / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D014591:Uterine Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
chemical_list: D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide