Our Summary

The research paper discusses a unique case of a 41-year-old woman who developed a rare post-surgery complication called uterocutaneous fistula. This happened after she underwent a surgery called abdominal myomectomy, which involves removing fibroids from the uterus. She had a consistent flow of pus from a small opening in the surgical scar on her abdomen. Doctors used an MRI and a special dye test to diagnose her with a uterocutaneous fistula, which means that an abnormal connection has formed between her uterus and her skin.

The woman then underwent another surgery designed to preserve her fertility, which successfully treated the fistula. The doctors discovered some non-absorbable silk stitches attached to a passageway in her body, which could have led to an infection and the development of the fistula.

The paper concludes that this type of fertility-preserving surgery can effectively treat a uterocutaneous fistula. It’s important that the surgery completely removes the problematic passageway and any surrounding dead tissue. A year after the surgery, the patient showed no signs of the fistula returning.

FAQs

  1. What is a uterocutaneous fistula?
  2. How is a uterocutaneous fistula diagnosed?
  3. What kind of treatment is effective for a patient with a uterocutaneous fistula?

Doctor’s Tip

A doctor may advise a patient undergoing myomectomy to follow postoperative care instructions closely to reduce the risk of complications such as uterocutaneous fistula. This may include avoiding heavy lifting or strenuous activity, taking prescribed medications as directed, and attending follow-up appointments to monitor healing. If any unusual symptoms such as persistent discharge or fever develop, the patient should seek medical attention promptly.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic uterine fibroids that are causing heavy menstrual bleeding, pelvic pain, pressure symptoms, or fertility issues. Myomectomy is often recommended for women who wish to preserve their fertility and have fibroids that are causing infertility. Additionally, myomectomy may be recommended for patients who have tried other treatment options for fibroids without success. It is important for patients to discuss their individual situation with their healthcare provider to determine if myomectomy is the appropriate treatment option for them.

Timeline

Before myomectomy:

  1. Patient experiences symptoms of uterine fibroids, such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient undergoes diagnostic tests, such as ultrasound or MRI, to confirm the presence and location of the fibroids.
  3. Patient discusses treatment options with their healthcare provider, including myomectomy as a surgical option to remove the fibroids while preserving the uterus.

After myomectomy:

  1. Patient undergoes the myomectomy surgery to remove the fibroids from the uterus.
  2. Patient experiences a recovery period, which may include pain, bleeding, and restrictions on physical activity.
  3. Patient follows up with their healthcare provider for postoperative care and monitoring.
  4. In rare cases, like in the case report mentioned above, patient may develop complications such as uterocutaneous fistula.
  5. Patient undergoes further diagnostic tests to confirm the diagnosis of uterocutaneous fistula.
  6. Fertility-sparing surgery is performed to correct the uterocutaneous fistula, involving the removal of the sinus tract and surrounding necrotic tissue.
  7. Patient is monitored for recurrence of the uterocutaneous fistula in the following years.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What are the potential risks and complications associated with myomectomy surgery?
  2. How long is the recovery period after myomectomy?
  3. Will my fertility be affected by the myomectomy procedure?
  4. What are the chances of developing uterocutaneous fistula after myomectomy?
  5. How is uterocutaneous fistula diagnosed and treated?
  6. What is the success rate of repairing uterocutaneous fistula?
  7. Are there any specific precautions or steps I can take to prevent uterocutaneous fistula after myomectomy?
  8. How often should I follow up with my doctor after myomectomy surgery?
  9. Are there any lifestyle changes I should make to improve my recovery and reduce the risk of complications?
  10. Can you provide me with more information or resources about uterocutaneous fistula and its treatment options?

Reference

Authors: Wang Y, Wang S, Shi H, Lang J. Journal: J Obstet Gynaecol Res. 2021 Sep;47(9):3392-3395. doi: 10.1111/jog.14863. Epub 2021 Jul 6. PMID: 34229365