Utero-Abdominal Wall Fistula (UAWF) is a very rare complication of cesarean section. We report an unusual case of a UAWF occurring in a 37-year-old woman, 4 years after a cesarean section and previously radical surgery for deep infiltrating endometriosis (DIE) with bowel resection. The patient presented with persistent purulent discharge of the Pfannenstiel scar and had noted that the discharge was blood-stained during menstruation. Magnetic resonance imaging confirmed the diagnosis of UAWF. Surgery was performed by laparotomy and was complicated by a postoperative rectovaginal fistula (RVF) which was successfully treated by the placement of a biological mesh via the vagina route. The postoperative course was favorable at 6 months with disappearance of painful symptoms and good quality of the colorectal anastomosis. A systematic review was conducted and 18 case reports were found from 1939 to 2016. This case report highlights the risk of post-delivery complications in women with DIE and colorectal involvement especially after cesarean section. Persistent abdominal discharge in this context should suggest a diagnosis of UAWF despite its low incidence. Finally, the vaginal route for RVF might be considered as an option for patients with prior multiple laparotomies.

作者：Chloé, Chattot；Patrick, Aristizabal；Sofiane, Bendifallah；Emile, Dara?

来源：Journal of minimally invasive gynecology 2017 年