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A posterior uteroperitoneal fistula: an unexpected finding
Katherine L Dengler1, Payam Katebi Kashi2, Angela M DiCarlo-Meacham1
1Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Obstetrics and Gynecology, INOVA Fairfax Medical Center, Falls Church, Virginia.
Fertility and Sterility
|February 24, 2021
Summary
This case report details the successful robot-assisted laparoscopic excision of a posterior uteroperitoneal fistula, a rare cause of infertility and pelvic pain. Surgical repair led to significant symptom improvement.
Area of Science:
- Gynecologic Surgery
- Minimally Invasive Procedures
- Female Reproductive Health
Background:
- Posterior uteroperitoneal fistulas are rare, often presenting with secondary infertility, pelvic pain, and dysmenorrhea.
- Potential etiologies include unrepaired hysterotomy extensions or chronic inflammation from deep infiltrating endometriosis.
- These fistulas can adversely affect fertility by disrupting sperm function or endometrial quality.
Observation:
- A 33-year-old woman with a history of cesarean section presented with secondary infertility and pelvic pain.
- Hysterosalpingography revealed a posterior uteroperitoneal fistula.
- Robot-assisted laparoscopy identified a uterine mass and fistula tract, unrelated to the cesarean scar.
Findings:
- Robot-assisted laparoscopic excision of the fistula tract and mass was performed.
- The uterus was repaired in multiple layers with a tension-free closure.
- The patient experienced significant improvement in pelvic pain, dysmenorrhea, and infertility symptoms post-surgery.
Implications:
- This case highlights a unique presentation of a posterior uteroperitoneal fistula potentially linked to endometriosis.
- Robot-assisted laparoscopic excision is an effective minimally invasive approach for treating such fistulas.
- Pelvic pain, dysmenorrhea, and infertility warrant suspicion for uteroperitoneal fistula, necessitating prompt diagnosis and surgical management.
