Diagnosis and management of uterocutaneous fistula following cesarean section: A case report

Jawaher Hammadi, Soukeina Jaballah, Yasmine B. Ali, Jihene B. Haj, Nour Rouis, Samar Knaz, Sana Ghades, Mohamed R. Fatnassi

Abstract

Uterocutaneous fistula following cesarean delivery is an exceptionally rare complication, defined by an abnormal tract between the uterine cavity and the abdominal scar. We report a 28-year-old woman who presented three months and half after a cesarean section with cyclical bloody discharge from a Pfannenstiel scar, preceded by a superficial wound infection. Pelvic magnetic resonance imaging (MRI) precisely delineated the tract, revealing a 21 mm anterior uterine wall defect communicating with a 25 mm subcutaneous collection, and informed surgical planning. Management included complete fistulectomy with layered uterine repair, followed by a three month course of a gonadotropin-releasing hormone (GnRH) analogue. Postoperative recovery was uneventful, with no recurrence during follow-up. This case highlights an infection-associated delayed presentation and illustrates the value of quantitative MRI mapping combined with short-course hormonal suppression to achieve durable closure while preserving fertility.

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References

Cicinelli R, Cicinelli E, Crupano F, Vinciguerra M, Lamanna B, Vimercati A. A rare but troublesome complication of cesarean section: the uterocutaneous fistula. Report of two cases and review of literature. Case Rep Perinat Med. 2022;11(1):20210057. doi:10.1515/crpm-2021-0057

Coumary S, Galidevara I, Naga Daliya V, Ghose S. Utero-cutaneous fistula following caesarean section. BMJ Case Rep. 2024;17(2):e255901. doi:10.1136/bcr-2023-255901

Czogalla B, Trillsch F, Burges A. Cyclic transcutaneous bleeding after repeated cesarean section deliveries. Am J Obstet Gynecol. 2018;219(2):202. doi:10.1016/j.ajog.2018.03.006

Etrusco A, Fabio M, Cucinella G, de Tommasi O, Guastella E, Buzzaccarini G, Gullo G. Utero-cutaneous fistula after caesarean section delivery: diagnosis and management of a rare complication. Przeglad Menopauzalny Menopause Rev. 2022;21(3):214-217. doi:10.5114/pm.2022.119263

Hasan JN, Musa DH, Mohammed AA. Uterocutaneous fistula after cesarean section; Case report. Int J Surg Case Rep. 2021;89:106621. doi:10.1016/j.ijscr.2021.106621

Hefny AF, Nambiar R, Jagdish J, Bashir MO. Utero-cutaneous fistula following Caesarean section. ANZ J Surg. 2019;89(5):E218-E219. doi:10.1111/ans.14249

Jadib A, Tabakh H, Chahidi El Ouazzani L, Kardi O, Siwane A, Touil N, Kacimi O, Chikhaoui N. Utero-cutaneous fistula following cesarean section: A case report. Radiol Case Rep. 2022;17(1):77-79. doi:10.1016/j.radcr.2021.09.069

Jindal A, Chaudhary H, Thakur M. Tubercular uterocutaneous fistula after caesarean section: A case report. Case Rep Womens Health. 2018;17:3-4. doi:10.1016/j.crwh.2018.02.001

Makroum AA, Taman ME. Challenges and management debates of uterocutanous fistula. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. Published online May 19, 2025. doi:10.1002/ijgo.70227

Shah N, Changede P, More V. Laparoscopic Management of Post-Cesarean Section Uterocutaneous Fistula. J Obstet Gynecol India. 2019;69(4):380-382. doi:10.1007/s13224-018-1197-2

Thubert T, Denoiseux C, Faivre E, Naveau A, Trichot C, Deffieux X. Combined conservative surgical and medical treatment of a uterocutaneous fistula. J Minim Invasive Gynecol. 2012;19(2):244-247. doi:10.1016/j.jmig.2011.10.010.

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