EC Gynaecology

Objective: To report a case of intra- uterine fistula with continuous endometrial cavity liquid misdiagnosed as hydrosalpinx

Design: Case report.

Setting: ART Fertility Clinics, Abu Dhabi, United Arab Emirates.

Patient: A 38-year-old woman with an intra-uterine fistula after laparoscopic myomectomy and bilateral salpingectomy following a uterine artery embolization, leading to chronic presence of intracavitary liquid collection.

Materials and Methods: Informed consent was obtained from the patient to have her case published in a scientific journal.

Intervention(s): 3-D vaginal ultrasound.

Main Outcome Measure(s): Not applicable.

Result(s): Cancellation of multiple cycles of endometrial preparation for frozen embryo transfer due to endometrial cavity liquid even after bilateral salpingectomy.

Conclusion(s): Uterine fistula are rare and the diagnosis is challenging. One should always consider this etiology in patients with continuous endometrial cavity fluid after myomectomy and uterine artery embolization.

Keywords: Uterine Artery Embolization; Fistula; Myomectomy; Hydrosalpinx; Endometrial Cavity Liquid

1. Buttram VC and Reiter RC. “Uterine leiomyomata: etiology, symptomatology, and management”. Fertility and Sterility 36 (1981): 433-445.
2. Ravina JH., et al. “Arterial embolization to treat uterine myomata”. Lancet 346 (1995): 671-672.
3. Dariushnia SR., et al. “Society of Interventional Radiology Standards of Practice Committee: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata”. Journal of Vascular and Interventional Radiology 25 (2014): 1737-1747.
4. Sultana CJ., et al. “Vesicouterine fistula after uterine artery embolization: a case report”. American Journal of Obstetrics and Gynecology 187 (2002): 1726-1727.
5. Donnez O., et al. “Unusual complication after uterine artery embolization and laparoscopic myomectomy in a woman wishing to preserve future fertility”. Fertility and Sterility 90 (2008): 5-9.
6. Ogliari KS., et al. “A uterine cavity-myoma communication after uterine artery embolization: two case reports”. Fertility and Sterility 83 (2005): 220-222.
7. Peivandi S., et al. “Uterine cavity-myoma fistula after hysteroscopic myomectomy mimicking uterine perforation at hysterosalpingography: case report”. The Journal of Minimally Invasive Gynecology 18 (2011): 534-537.
8. De Iaco P., et al. “Uterine fistula induced by hysteroscopic resection of an embolized migrated fibroid: a rare complication after embolization of uterine fibroids”. Fertility and Sterility 75 (2001): 818-820.
9. Hajati A. “Endometrial cavity-myoma fistula after uterine artery embolization diagnosed by pelvic MRI: case report”. Radiology Case Reports (2021): 2916-2919.
10. Walker W and Worthington-Kirsch RL. “Fatal septicaemia after fibroid embolization”. Lancet 354 (1999): 1730.
11. Serres-Cousine O., et al. “Clinical investigation of fertility after uterine artery Embolization”. American Journal of Obstetrics and Gynecology (2021): 1.e1-1.e22.
12. Laughlin-Tommaso SK. “Alternatives to Hysterectomy”. Clinical Obstetrics and Gynecology 43 (2016): 397-413.
13. Marret H., et al. “Therapeutic management of uterine fibroid tumors: updated French guidelines”. European Journal of Obstetrics and Gynecology and Reproductive Biology 165 (2012): 156-164.
14. Carranza-Mamane B., et al. “The Management of Uterine Fibroids in Women with Otherwise Unexplained Infertility”. Journal of Obstetrics and Gynaecology Canada 37 (2015): 277-285.
15. Felemban A., et al. “Uterine restoration after repeated expulsion of myomas after uterine artery embolization”. The Journal of the American Association of Gynecologic Laparoscopists 8 (2001): 442-444.
16. Lawrenz B., et al. “Isthmocele and ovarian stimulation for IVF: considerations for a reproductive medicine specialist”. Human Reproduction (2019): 1-11.
17. D’Arpe S., et al. “Management of hydrosalpinx before IVF: A literature review”. Journal of Obstetrics and Gynaecology (2014): 1-4.
18. Sokalska A., et al. “Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses”. Ultrasound in Obstetrics and Gynecology 34 (2009): 462-470.
19. Engin T., et al. “Role of Three-Dimensional Ultrasound in Gynecology”. The Journal of Obstetrics and Gynecology of India 65 (2015): 146-154.