The path of least resistance: A case of cervical stenosis and uterocutaneous fistula☆

Uterocutaneous fistula is exceedingly rare, and uniformly follows some type of operative procedure. In this case, a young woman underwent a cesarean delivery at an outlying clinic in rural Nigeria, following which she developed amenorrhea and cyclic pelvic pain. In attempts to resolve her condition, a second laparotomy was performed at the same medical center. She presented to us 2 weeks later, at which time an opening was present at the healing laparotomy scar, severe vaginal scarring and cervical stenosis were present, and marked hematometra was seen on ultrasound. Following a procedure to open her cervix, she began menstruating through a fistulous tract in her abdomen, which we subsequently excised and closed with no further problems for the patient. This case highlights the challenge in developing countries of surgical complications resulting from a lack of appropriately trained physicians in rural medical centers. We suggest that focus on excellent training of our young physicians and the creation of incentives to place and keep fully qualified physicians in such hospitals will improve this situation.