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Case Report

Uterine skin penstock: singular entity

Selvakumar K, Madhangi Baskaran, Indrajit Anandakannan, Ashwin Retnam.

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A fistula is an abnormal communication between two epithelial surfaces; a uterocutaneous fistula is extremely rare. 26-year-old female with seropurulent discharge from the post-lower segment caesarean section (LSCS) scar for 45 days postpartum. In view of the sinus, an x-ray sinogram was done, which revealed a fistulous tract of length 7 cm anteroposteriorly, with the subcutaneous collection extending into the endometrial cavity with multiple arborizations. Intra-operatively, communication with the endometrial cavity was ascertained. An elective laparotomy with exploration and removal of the fistulous tract was performed. On exploration, the wall of the uterus was found to be irreparable. Subtotal hysterectomy with bilateral salpingectomy, peritoneal lavage, and closure. Infection must be treated with appropriate antibiotics and drainage of any abscess. Surgical management is the mainstay in the treatment of fistulas. Medical treatment using GnRH agonists for six months has been described in the literature. Conservative treatment, including resection of the fistula tract and closure of the uterus, should be considered with a risk of recurrence.

Key words: Fistula, Uterocutaneous Fistula, Post-LSCS Scar Fistula

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