PC-GG33 : Uterocutaneous fistula after High-Intensity Focused Ultrasound : a case report

We report a case of uterocutaneous fistula in a 46-year-old woman who underwent High-Intensity Focused Ultrasound(HIFU). She is a Korean who lives in Kazakhstan. She had heavy menstrual bleeding and suspected of adenomyosis and myoma. She had been recommended for hysterectomy, but she never wanted to undergo hysterectomy, just treated with hormone therapy and received blood transfusions every few months. The patient finally received HIFU in Korea and returned to Kazakhstan shortly after. She felt fever and pain in the abdominal wall at the time of the procedure, and subsequently relived the pain but sustained discharge in that area and took antibiotics. Because of persistent heavy menstrual bleeding and pelvic pain, she recommended to receive hysterectomy in Kazakhstan. But she refused and underwent wound debridement and primary closure of abdominal wall injury at the hospital that performed HIFU in South Korea, and strongly rejected further surgery. Five months after the procedure, blood was drawn from the wounds of the abdomen at the time of menstruation and referred to our hospital. At the midline of abdominal ASIS level, a discharge was observed through the abdominal wall skin opening and there was extensive redness in the lower abdomen around that. The abdomen MRI showed a heterogenous myoma on the right side of the uterus and adenomyosis with a non-enhancing cavitary portion on the left side and fundus of the uterus, which appeared to be necrosis inside. The cavitary portion of the adenomyosis was suspected to be connected to the uterine cavity and formed fistulous tract through anterior abdominal wall. Peritoneal and fat infiltration around the tract was seen. So, she underwent total abdominal hysterectomy with bilateral salpingectomy in gynecology and abdominoplasty in plastic surgery. This is the first report of uterocutaneous fistula after HIFU procedure and it is important to keep in mind that this type of complication may occur when performing HIFU.