Case Report

Tubacutaneus Fistula

Presentant: Kevin Ardiansyah

NIM : 11-2013-265
Consulant: dr. Johan M Hutabarat Sp.OG
RSUD TARAKAN
DEPARTMENT OF OBSTETRY AND GYNECOLOGY

Introduction
Gynecologist is familiar with : vesicovaginal,
uretrovaginal, and rectovaginal fistulae.
Fistula Tubacutaneus is rare case , no case is reported
regarding tubocutaneus fistula.
In this case , the fistula tubacutaneus is developed
after treating the pelvic abscess.
The fistula extended from the right fallopian tube to
the right groin along the anatomical path of the round
ligament.

Case Report
A 40 years old woman with 2 previous normal
deliveries presented to surgeon at Kings Mill
Hospital in april 2013 :
3-year history of intermittently discharging
persistent right groin sinus.
The discharge is purulent

Past medical history

Laparotomy for ruptured pyosalphinx in 2000
Recurrent abdominal pain in 2008 and 2011
Give antiobiotic and option to pelvic clearance and
then the patient have conservative management

Case Report
Examination
Surgeon noted Discharging sinus of the right groin w/ d : Hidraadenitis.
CT Sinogram Extending from the right groin crease to the right adnexa with
the contrast tracking behind uterus and the upper vagina
Then the patient referred to the gynecology team

Gynecological assesment and examination

History Right illiac fossa pain and constant discharge from the right groin
sinus.
Abdominal Midline laparatomy scar and discharhing right groin sinus.
Pelvic Reduced mobility of the pelvic organ and thickening of right adnexal
region

Case Report
After liaising with the surgeon
The plan made for laparotomy, right salphingoooforektomi,
and excition of fistulous tract
The patient was informed regarding the risk to adjecent
vascular structures due to proximity of the tract to the major
blood vessels.

May 27 2014
the patient had laparotomy under the joint care of the
gynecologist and surgeon.
Result :
Normal left tube and ovary which was attached to left pelvic
side wall.
The uterus was normal and she had normal right ovary and
right pyosalphinx

Case Report
Result
The fistulous tract was communicating to the
cornual end of the fallopian tube posterior to the
round ligament; it then followed the path of the
round ligament opening at the level of the
inguinal ring in the right groin

Case Report
Operation procedure
Right salphingektomi was performed
Right round ligament was divided near the right
cornual end of the uterus; a right groin fistulous
tract of 3 cm was excised.

Histophatology
Pyosalphinx with the features of chronic and acute
inflammation with microabscesses and fistulous
tract showing inflammatory granulation tissue
without evidence of malignancy.

The patient was discharged home on the 3rd post

operative day

Case Report
Then the patient was readmitted on the 6th post
operative day with headache.
Then she was seen by anesthetist who treated her
with a blood patch for postdural headache.
The patient made good postoperative recovery
followed by the bloodpatch and she was discharged
home on the 8th postoperative day.
8 weeks later the patient reviewed in clinic , she had
made a good recovery with completely healed right
groin wound and laparotomy scar

Discussion
The communication between the fallopian tube
and skin is very rare.
Etiology

Obstetric surgical
Pelvic inflammatory disease
Endometriosis
Tuberculosis
Pelvic irradiation
Inflammatory bowel disease
And pelvic surgery

Discussion
In our case
The fistulous tract : following the path of the round ligament
and it has developed after recurrent episodes of pelvic
inflammatory disease

HSG , ultrasound, CT, and MRI are investigation

modalities of choice
The treatment depends on the age of the patient and the
fertility option of the women.
Fistulas to the fallopian tube are rare and their
management is not very well described

Discussion
Most studies advocate fistula resection and
salpingektomy as the only feasible method of
treating this rare disease to prevent the
occurence of ectopic pregnancy.

Conclusion
Tubocutaneus fistule is rare
their management is not well described in the
literature.
Salpingectomy, resection of fistulous tract, and
treating the underlying cause are the treatment of
choice.
Early diagnosis and treatment of these patient are
essential for avoiding long term complication

Conflict of interest
The authors declare that they have no conflict of
interests.

TERIMA KASIH