What to monitor in a patient with a colo-uterine fistula?

From the Guidelines

Patients with a colo-uterine fistula should be closely monitored for signs of infection, nutritional status, and complications, with a focus on optimizing their preoperative condition to reduce morbidity and mortality. When managing these patients, it is crucial to track several key clinical parameters, including:

• Signs of infection such as fever, elevated white blood cell count, and increased C-reactive protein levels 1
• Vaginal discharge characteristics, particularly the presence of fecal material, which is a hallmark symptom of colo-uterine fistula
• Abdominal pain, pelvic discomfort, and changes in bowel habits
• Nutritional status and hydration, as malnutrition is a common issue due to poor nutrient absorption 1 Regular blood tests should include complete blood count, electrolytes, and inflammatory markers. Imaging studies such as CT scans with contrast or MRI should be performed to evaluate fistula progression or resolution. It is also essential to assess the patient's quality of life and psychological well-being, as this condition can cause significant emotional distress. Monitoring for complications like peritonitis or sepsis, which require immediate intervention, is critical. For patients awaiting surgical repair, ensuring adequate preoperative optimization, including correction of anemia, malnutrition, and control of any active infection, is vital, as early nutritional support can decrease the occurrence and severity of fistulas 1. This comprehensive monitoring approach is essential because colo-uterine fistulas represent an abnormal connection between the colon and uterus that can lead to serious complications if not properly managed.

From the Research

Monitoring a Patient with Colo-Uterine Fistula

To monitor a patient with a colo-uterine fistula, the following aspects should be considered:

• Clinical symptomatology:
  • Vague abdominal pain localized in the left iliac cavity 2, 3
  • Emission of blood, purulent material, and stools from the vagina 2
  • Fever and pyuria 4
  • Abdominal pain, blood in stools, and whitish discharge from vagina 3
• Diagnostic procedures:
  • Barium enema 2
  • Fallopian tube endoscopy 2
  • Colon endoscopy 2
  • Oral administration of non-absorbable substances to be searched in the vaginal tampon 2
  • Computed tomography (CT) scan 5, 3
  • Contrast-enhanced CT (CECT) 3
  • Ultrasound 3
• Therapeutic management:
  • Colic resection en bloc with the uterus 2
  • Hartman operation in emergency cases 2
  • Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus 5
  • Hysterectomy, sigmoid resection, and primary colorectal anastomosis or diverting colostomy 4

Potential Complications

Potential complications of colo-uterine fistula include:

• Septic complications 2
• Myometrial abscess cavity in the uterus 5
• Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus 5
• Urinary tract infection 6
• Bleeding from the enterovaginal fistula 6