Management of Fecal Drainage After Fibroid Uterus Surgery
Fecal drainage following fibroid surgery represents a surgical emergency requiring immediate evaluation for a uteroenteric (bowel-uterine) fistula, which mandates surgical repair with bowel resection, hysterectomy, and possible fecal diversion. 1
Immediate Assessment and Diagnosis
- Obtain urgent contrast-enhanced CT imaging to identify the fistula tract between the bowel and uterus or surgical site 2
- Look specifically for collections, abscess formation, and communication between the gastrointestinal tract and gynecologic structures 2, 3
- This complication, while rare, has been documented after uterine fibroid embolization when fibroids undergo necrosis and create fistulous connections to adjacent bowel 2
Surgical Management
Major anatomic defects such as uteroenteric fistulas must be surgically repaired - conservative management is not appropriate for this complication 1
The surgical approach typically requires:
- Total abdominal hysterectomy to remove the diseased uterus and fibroid tissue 2, 3
- Bowel resection of the affected intestinal segment (small bowel or colon depending on location) 2, 3
- Drainage of any associated abscesses or collections 2
- Possible temporary fecal diversion (colostomy or ileostomy) depending on the extent of contamination and bowel involvement 1
Mechanism and Risk Factors
- Large degenerating fibroids can become adherent to and compress bowel, particularly after procedures like uterine artery embolization that cause fibroid necrosis 2, 3
- Spontaneous expulsion of necrotic fibroid tissue through the cervix can create a pathway for fistula formation 2
- The fistula typically develops days to weeks after the initial fibroid procedure when tissue breakdown occurs 2
Critical Pitfalls to Avoid
- Do not delay surgical consultation - this is not simple fecal incontinence requiring conservative management 1
- Do not attempt conservative management with antibiotics alone - the anatomic defect requires surgical repair 1
- Do not confuse this with postoperative fecal incontinence - vaginal discharge containing enteric contents indicates a fistula, not sphincter dysfunction 2
Postoperative Considerations
After surgical repair:
- Patients typically require nutritional support given the catabolic state from infection and bowel surgery 3
- Broad-spectrum antibiotics to cover polymicrobial contamination 2
- If temporary fecal diversion was performed, plan for reversal once healing is complete (typically 3-6 months) 1
The prognosis after appropriate surgical management is generally good, with most patients making full recovery once the fistula is repaired and infected tissue removed 2, 3