Abstract
The incidence of uterine fistula following a Cesarean section is reported to be 6.6%. The menstrual fistula is known as the cause of dysmenorrhea and irregular uterine bleeding. We experienced a case of large uterine wall scarred fistula successfully repaired by a laparoscopic surgery. The patient was 24 years old, gravida 3 para 2, female. She delivered her 2 offspring by cesarean sections. After 13 months following the last operation, she was referred to our institution with the chief complaint of prolonged menstruation. A hematoma of 5cm in diameter, located on the surface of the vesicouterine pouch, and the uterine wall defects from dehiscence of the Cesarean section scar were observed by the ultrasound scan and MR imaging. Follow the 6 months of the Gn-RHa administration, a surgical repair was performed. By laparoscopic observation, a hematoma covered by thin membrane was found at vesicouterine pouch, and the membrane was incised. Upon opening the hematoma, the uterine wall fistula was identified as a defect, as wide as the half length of the lower uterine segment. After removing the scar tissue, the uterine wall was sutured by 2 layers using 1-0 Monocryl. 1.5 months after operation, her menstruation was recovered and the patient has no previous complaints.
