IJCRR - Vol 07 Issue 13, July, 2015
UTERORECTAL FISTULA MANIFESTING DURING SECOND TRIMESTER OF PREGNANCY AS MASSIVE LOWER GASTROINTESTINAL BLEEDING: IS IT A MENACE OF MTP?
Author: Papa Dasari
A 27-year-old G2 A1 post IVF conception, DADC twins was hospitalized at 11 weeks with a diagnosis of threatened abortion.. History documented included that she conceived soon after marriage 5 years ago and underwent MTP by surgical method (D&E) at 8 weeks of pregnancy following which she suffered from secondary infertility. Laparoscopy for evaluation of secondary infertility a year ago revealed bilateral tubal block and she was treated with ATT for 6 months elsewhere. She conceived following second attempt of IVF. At admission, she had mild bleeding and USG confirmed DADC twins with good cardiac activity and the
placenta of the first twin was posterior encroaching Os and that of second twin was also posterior wall but near fundus of the uterus .She was managed conservatively with bed rest, progesterone support and psychological support. She expelled the first fetus at 16 weeks following 18 days of leaking. Conservative management was continued. At 20 weeks she developed leaking from the second sac and developed severe pain abdomen and acute gush of bleeding per rectum. USG revealed empty uterus and the fetus outside the uterus. Emergency laparotomy with a provisional diagnosis of spontaneous rupture uterus revealed a large rent on the posterior surface of uterus and anterior rectal wall and the fetus which was in the rectosigmoid was extracted by squeezing. There was a mucus fistula between the uterus and rectum. Uterine rent was closed and colostomy was done. She was discharged home with advice to opt for surrogacy or adoption.
Keywords: Medical termination of pregnancy, Secondary infertility, Bilateral tubal block, IVF, Acute gastrointestinal haemorrhage, Uterorectal fistula
Papa Dasari. UTERORECTAL FISTULA MANIFESTING DURING SECOND TRIMESTER OF PREGNANCY AS MASSIVE LOWER GASTROINTESTINAL BLEEDING: IS IT A MENACE OF MTP? International Journal of Current Research and Review. Vol 07 Issue 13, July, 25-28
1. Martin DH, Hixson CH and Wilson EC. Enterouterine fistula. Obstet Gynecol. 1956; 7:466-469.
2. Uzan J,Koskas M, Fournier P, Marguiles AL, Luton D,Yazbeck C. Colouterine fistula after polymyomectomy: a Case report. Journal of Medical Case Reports. 2014, 8:199-202.
3. Ekwaro L,Kizza PM, Nassali G,Lubega J. Ectopic pregnancy: Unusual cause of lower GIT bleeding. A Case report East and Central African Journal of Surgery, 2004; 9: 5-7
4. P Pinto, L Sharma, P.Kini Chronic uterorectal fistula with menochezia and amenorrhea. IJGO.1990;
5. Siganeshan V, Willis IH, Zarate LA,Howard L,Robinson MJ. Colouterine fistula secondary to endometriosis with associated chorioamnionitis. Obstet Gynecol 2006; 107:451–3
6. Shaw FM, Renius JF, Leiken EL, Tejani N. Recurrent chorioamnionitis and second trimester abortion because of an enterouterine fistula. Obstet Gynecol.1995;86:639-641.