Postmyomectomy uterocutaneous fistula: a case report and literature review

Uterocutaneous fistula (UCF) is an uncommon clinical entity. The aetiology and optimal treatment strategy of UCF are still not clear. GnRHa (gonadotropin-releasing hormone agonist) treatment as an option for conservative hormone therapy for UCF has diverse clinical outcomes. The true status of hormone receptors in UCF lesions and its relationship with the therapeutic effect of GnRHa treatment have not yet been studied.

A 39-year-old woman underwent an uneventful myomectomy during her initial visit to our centre. The patient returned to our centre with complaints of fluid oozing from her abdominal wound. Misdiagnosed with poor wound healing, the patient received a secondary closure. Consequent blood-stained drainage from the wound during menstruation and imaging tests confirmed the diagnosis of UCF. Surgical repair and excision of the fistula tract were performed. Histopathological analysis revealed fistulization and a negative status of hormone receptors in the fistula. Considering the controversial role of GnRHa treatment in UCF and the negative oestrogen receptor (ER) and progesterone receptor (PR) status in the current case, we further systematically reviewed the literature for GnRHa treatment for UCF, with the results showing that GnRHa manipulation as a conservative hormone therapeutic schedule is effective in 2 (50%) of the 4 patients in which it was attempted.

UCF is a rare entity and tends to be misdiagnosed. GnRHa as a conservative therapy for UCF has different clinical outcomes. The current finding of a negative hormone receptor status in the fistula may provide new clues for further exploration of the mechanisms of the diverse therapeutic effects of GnRHa on UCF.