García-Hernández GG, Hernández-Pérez SY, Jiménez-Ibáñez LC

Language: Spanish
References: 0
Page: 762-767
PDF size: 201.76 Kb.

ABSTRACT

Background: Fistula is an abnormal communication between two epithelialized surfaces. Caesarean section is the most frequent cause of uterine-cutaneous fistula, with an incidence of no more than 0.4%. Menstrual bleeding through the surgical wound is an almost pathognomonic finding. The diagnosis can be made using fistulography, transcervical injection of methylene blue, computerized tomography with contrast, as well as magnetic resonance or hysterosalpingography. Currently, the treatment of choice continues to be the surgical excision of the fistulous tract with or without hysterectomy.
Clinic case: Female patient of 25 years of age with a history of three caesarean sections;; last in February 2018. As transoperative finding: uterus easily bleeding and friable leaving Penrose drainage to the left iliac fossa, which is removed 72 hours later. He came to the clinic for a condition of 22 days of evolution characterized by hyperthermia, pelvic pain and foul-smelling discharge through a previous drainage wound. When presenting menstrual bleeding, she sees discharge by surgical wound site. On examination: Penrose drainage scar of granulomatous appearance and purulent exudate, suspecting cutaneous uterus fistulous tract, so fistulography is performed with iodinated non-ionic contrast medium and tomography. We proceed to fistulectomy with hysterectomy. He is currently a patient with favorable clinical evolution.
Conclusion: Although the uterine-cutaneous fistula is a really exceptional problem, even so, it should be considered after the cesarean section. The pathognomonic clinical data is menstrual bleeding through the surgical wound. The accurate diagnosis is precise, with the demonstration of the path of the fistula by means of fistulography, transcervical injection of methylene blue, contrasted computed tomography, magnetic resonance or hysterosalpingography.