Uterocutaneous fistula following cesarean section: a case report

This case report details the clinical journey of a 37-year-old woman, gravida 6 para 6 + 1, who presented with persistent purulent discharge from her cesarean section scar following an elective cesarean delivery. Her obstetric history included two uncomplicated vaginal deliveries and four cesarean sections, with significant complications in the previous pregnancies, including gestational diabetes and placenta previa. Notably, ultrasound findings during her most recent pregnancy raised concerns for placenta accreta spectrum. Despite a vertical midline incision for cesarean delivery and intraoperative findings confirming placenta accreta, the patient developed a chronic purulent discharge approximately two months post-surgery, resistant to multiple courses of antibiotics. Evaluation revealed a hypoechoic area and CT imaging suggested postoperative scarring. Pelvic MRI confirmed the diagnosis of a uterocutaneous fistula (UCF). Management initially involved antibiotic therapy; however, surgical intervention became necessary due to persistent symptoms. During surgery, extensive adhesions were identified, along with the fistulous tract. A total hysterectomy was performed without immediate complications, and the patient was discharged in stable condition within a week. This case underscores the complexities of managing postoperative complications in patients with significant obstetric histories and highlights the importance of multidisciplinary approaches in challenging surgical scenarios.