{"paper_id":"e815c492-fdaa-4b1f-a9b4-7dbd45485495","body_text":"Fertility-preserving management of post-adenomyomectomy enterocutaneous fistula with GnRH analogue\nDOI:\nhttps://doi.org/10.18203/2320-1770.ijrcog20252751Keywords:\nAdenomyosis, Adenomyomectomy, Uterocutaneous fistula, GnRH analogueAbstract\nUterocutaneous fistula is a rare pathological communication between the uterine cavity and the anterior abdominal wall, typically presenting with cyclical menstrual discharge through a cutaneous opening. While most cases occur following Caesarean sections or open myomectomy, this case describes an unusual presentation following adenomyomectomy in a 32-year-old nulligravida. The patient initially presented with symptoms suggestive of uterine fibroids but was intraoperatively found to have adenomyosis, for which adenomyomectomy with uterine reconstruction was performed. Four weeks postoperatively, she developed a localized swelling on the lower abdominal wall, which ruptured with the onset of menstruation, discharging blood through both the skin and vagina. Ultrasonography confirmed a hypoechoic tract connecting the uterus to the cutaneous swelling, consistent with uterocutaneous fistula. The patient was successfully managed non-surgically using monthly subcutaneous Goserelin injections for three months, resulting in spontaneous closure of the fistulous tract and resolution of symptoms. This case highlights the diagnostic challenges of differentiating adenomyosis from fibroids using 2D ultrasonography, as well as the importance of considering rare postoperative complications such as uterocutaneous fistula. It underscores the potential role of medical therapy with GnRH analogues as a fertility-preserving alternative to surgery in select cases, contributing to improved clinical outcomes and patient quality of life.\nMetrics\nReferences\nEtrusco A, Fabio M, Cucinella G, de Tommasi O, Guastella E, Buzzaccarini G, et al. Utero-cutaneous fistula after caesarean section delivery: diagnosis and management of a rare complication. Prz Menopauzalny. 2022;21(3):214-7. DOI: https://doi.org/10.5114/pm.2022.119263\nKucha K, Vaishnav H, Damor P, Yagnik A, Desai G, Maitra N. Utero cutaneous fistula after caesarean section: a case report. Int J Repro Contra Obstet Gynecol. 2024;13(11):3391–4. DOI: https://doi.org/10.18203/2320-1770.ijrcog20243215\nHasan JN, Musa DH, Mohammed AA. Uterocutaneous fistula after cesarean section; Case report. Int J Surg Case Rep. 2021;89:106621. DOI: https://doi.org/10.1016/j.ijscr.2021.106621\nYesiladali M, Saridogan E. Successful pregnancy and delivery following surgical treatment of postmyomectomy uterocutaneous fistula. BMJ Case Reports. 2019;12:231594. DOI: https://doi.org/10.1136/bcr-2019-231594\nTaran FA, Weaver AL, Coddington CC, Stewart EA. Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Hum Reprod. 2010;25(5):1177-82. DOI: https://doi.org/10.1093/humrep/deq034\nExacoustos C, Brienza L, Di Giovanni A, Szabolcs B, Romanini ME, Zupi E, et al. Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology. Ultrasound Obstet Gynecol. 2011;37(4):471-9. DOI: https://doi.org/10.1002/uog.8900\nHanafi M. Ultrasound diagnosis of adenomyosis, leiomyoma, or combined with histopathological correlation. J Hum Reprod Sci. 2013;6(3):189-93. DOI: https://doi.org/10.4103/0974-1208.121421\nSaremi A, Bahrami H, Salehian P, Hakak N, Pooladi A. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod Biomed. 2014;28(6):753-60. DOI: https://doi.org/10.1016/j.rbmo.2014.02.008\nNwogu CM, Ugwu AO, Soibi-Harry AP, Nwokocha SU. Uterocutaneous fistula postabdominal myomectomy: successful repair–case report and review of literature. Nigerian J Exp Clin Biosci. 2021;9(3):199-201. DOI: https://doi.org/10.4103/njecp.njecp_17_21\nMahto S, Ghimire R, Kunwar S, Saha R. Successful Outcome of Uterocutaneous Fistula: A Case Report. J Nepal Med Assoc. 2021;59(241):913-5. DOI: https://doi.org/10.31729/jnma.7034\nThubert 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):244-7. DOI: https://doi.org/10.1016/j.jmig.2011.10.010","source_license":"CC0","license_restricted":false}