Utero-Cutaneous Fistula Following Caesarean Section Secondary to Degeneration of Fibroid: A Rare Case

Uterocutaneous fistulae are extremely rarecompared to common cutaneous stulae involving ureteric and gastrointestinal tracts. Uterocutaneous stula is a rare complication following caesarean section with only a few cases published in literature. This is the second case report of utero-cutaneous fistula where the communication isbetween the endometrial cavity and skin lesion via a necrotic intramural fibroid followingcaesarean section (CS). A primigravida underwent classical caesarean CS in view of large lower segment intramural fibroid. She also underwent step wise devasularization for intractable PPH. After two months of initial CS she reported back with pus like discharge at the incision site. The diagnosis of utero-cutaneous fistula was made which was confirmed by MRI. At laparotomy, fibroid necrosis and stula tract was seen. Total abdominal hysterectomy with excision of fistulous tract was done. Histopathologic examination revealed intramural leiomyoma with extensive infarction. The case highlights this rare complication in uterine fibroid and caesarean section. Once a fistula is diagnosed, prompt timely intervention with excision of the fistulous tract is warranted.