Diagnosis and Management of Utero-Sigmoid Fistula Cases: Case Report

Berriandi Arwan, Andi Rinaldi, R. M. Sonny Sasotya, Eppy Dharmadi Achmad, Moch. Rizkar Arev Sukarsa


Abstract


Introduction: Intrauterine devices (IUDs) are a common form of contraception due to their affordability and effectiveness. But they can also result in migration into the myometrium, which can cause utero-sigmoid fistulas. Utero-sigmoid fistulas is a rare but dangerous side effect of intrauterine device migration, which can make diagnosis and device retrieval challenging. Here, we present a case report that highlights the diagnosis and the management of utero-sigmoid fistula.
Case Presentation: A 63-year-old woman came to the hospital due to feces appearing from her vagina. Later, it was confirmed from vaginal touch examination. On US examination, the IUD was found to have migrated to the deeper part of the uterus and a defect was confirmed as a fistula between the sigmoid colon and the uterus by contrast-enhanced abdominal MSCT. The patient then underwent a joint surgery consisting of wedge reesection of the uterus + fistula repair by the digestive surgery team, and hysterotomy + bilateral salpingectomy by the obgyn team. The procedure was success, and the fistula was closed, however the IUD was not retrieved during surgery. The patient had no early post-operative problem.
Conclusion: The management of utero-sigmoid fistulas varies greatly and is not standardized. The diagnosis can be confirmed by hysteroscopy or surgical exploration, although non-invasive imaging techniques like MRI can aid in the process. Even though utero-sigmoid fistulas are uncommon, physicians need to be aware of this possible IUD complications.

Diagnosis dan Tatalaksana Kasus Fistula Utero-Sigmoid: Laporan Kasus

Abstrak
Pendahuluan: Alat Kontrasepsi Dalam Rahim (AKDR) merupakan bentuk kontrasepsi yang umum digunakan karena harganya terjangkau dan efektif. Namun, AKDR dapat bermigrasi ke dalam miometrium yang dapat menyebabkan pembentukan fistula utero-sigmoid. Fistula utero-sigmoid adalah efek samping yang jarang terjadi tetapi berbahaya akibat migrasi AKDR. Migrasi AKDR dapat menjadi tantangan untuk diagnosis penyebab fistula utero-sigmoid dan penyulit saat prosedur pengambilan AKDR. Laporan kasus ini akan membahas mengenai diagnosis dan penanganan fistula utero-sigmoid.
Presentasi Kasus: Seorang wanita berusia 63 tahun datang ke rumah sakit mengeluhkan feses yang keluar dari vaginanya. Kemudian, hal itu dikonfirmasi saat pemeriksaan vagina. Pada pemeriksaan USG ditemukan IUD yang berpindah ke bagian uterus yang lebih dalam dan suatu defek yang terkonfirmasi sebagai fistula antara kolon sigmoid dan uters melalui MSCT abdomen dengan kontras. Kemudian pasien menjalani operasi bersama yang terdiri dari wedge reesection pada rahim + repair fistula oleh tim bedah digestif, dan histerotomi + salpingektomi bilateral oleh tim obgyn. Prosedur berjalan dengan baik dan fistula berhasil ditutup, namun AKDR tidak diambil pada saat operasi. Tidak didapati komplikasi akut pascaoperasi.
Kesimpulan: manajemen fistula utero-sigmoid sangat bervariasi dan belum terstandardisasi. Diagnosis dapat dikonfirmasi melalui histereskopi atau eksplorasi pembedahan, namun teknik pencitraan non-invasif seperti MRI dapat membantu proses diagnosis. Meskipun fistula utero-sigmoid jarang terjadi, klinisi tetap harus waspada akan komplikasi ini akibat dari IUD

Kata kunci: AKDR, Diagnosis, Fistula utero-sigmoid, manajemen,


Keywords


Diagnosis; IUD; Management; Utero-sigmoid Fistula

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DOI: http://dx.doi.org/10.24198/obgynia.v7i3.698

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