Scar Endometriosis Complicated with Utero-Cutaneous Fistula: Case Report: Case Report

Hawa Saleh Rezeg; Saad Younis Mostafa; Elmahaishi MS

doi:10.58372/2835-6276.1374

Authors

Hawa Saleh Rezeg
Saad Younis Mostafa
Elmahaishi MS

DOI:

https://doi.org/10.58372/2835-6276.1374

Keywords:

scar endometriosis, utero-cutaneous fistula, previous cesarean sections, cyclic cesarean scar bleeding

Abstract

Background: Scar endometriosis is a rare complication of cesarean delivery, and its progression to a utero-cutaneous fistula (UCF) is exceptionally uncommon. This paper describes a rare type of fistula after a long time of cesarean section, and increases awareness regarding this rare condition, which is often misdiagnosed.

Case presentation: We report the case of a 35-year-old multiparous woman with a history of three cesarean sections who presented with cyclic bleeding from a poorly healed Pfannenstiel scar and severe dysmenorrhea. Clinical examination revealed two discolored subcutaneous masses along the previous incision site. Ultrasonography and CT imaging demonstrated subcutaneous lesions adherent to the anterior uterine wall, while pelvic MRI confirmed a hyperintense tract establishing communication between the uterine cavity and the abdominal wall. The patient underwent wide surgical excision of the endometriotic masses with removal of the fistulous tract, reconstruction of the uterine wall, and placement of a mesh to repair the abdominal wall defect. Histopathology confirmed endometriosis and utero-cutaneous fistula. Postoperative recovery was uneventful, and symptoms resolved completely.

Conclusion: This case highlights the importance of considering scar endometriosis in women presenting with cyclic symptoms at previous cesarean sites and emphasizes the role of MRI in diagnosing rare complications such as UCF. Complete surgical excision remains the definitive and effective treatment.

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