Fertility-preserving management of post-adenomyomectomy enterocutaneous fistula with GnRH analogue

Fertility-preserving management of post-adenomyomectomy enterocutaneous fistula with GnRH analogue DOI: https://doi.org/10.18203/2320-1770.ijrcog20252751Keywords: Adenomyosis, Adenomyomectomy, Uterocutaneous fistula, GnRH analogueAbstract Uterocutaneous 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. Metrics References Etrusco 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 Kucha 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 Hasan 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 Yesiladali 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 Taran 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 Exacoustos 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 Hanafi 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 Saremi 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 Nwogu 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 Mahto 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 Thubert 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