Uterine-Abdominal Fistula Risk After Myomectomy
Uterine-abdominal (utero-peritoneal) fistula formation after myomectomy is an extremely rare complication, with only isolated case reports documented in the medical literature, making the precise incidence difficult to quantify but estimated to be well under 1%. 1, 2
Understanding the Rarity of This Complication
The available evidence consists entirely of case reports rather than large-scale studies, which indicates this is an exceptionally uncommon event:
A single case report from 2021 documented uterocutaneous fistula (a variant connecting the uterus to the skin) after abdominal myomectomy in a 41-year-old woman, attributed to nonabsorbable silk sutures causing infection and fistula tract formation 1
One case report from 2013 described utero-peritoneal fistula following laparoscopic myomectomy in a 36-year-old woman, diagnosed 2 years post-operatively and attributed to myomectomy scar dehiscence 2
Standard complication rates for abdominal myomectomy include a 12% overall complication rate (predominantly transient fever), 3% transfusion rate, and 2% major complication rate, but fistula formation is not listed among recognized complications 3, 4
Context: More Common Post-Myomectomy Complications
To put this in perspective, the recognized complications after myomectomy that clinicians should actually counsel patients about include:
- Uterine rupture during subsequent pregnancy is the most clinically significant concern, particularly when the uterine cavity is entered during surgery 3
- Fibroid recurrence occurs in 27% of patients at 10 years 3
- Standard surgical risks include uterine perforation, bleeding requiring transfusion, bowel or bladder injury, and infection 3
- Arteriovenous fistula formation (vascular, not cavity-communicating) has been reported as a rare but more recognized complication 5
Important Distinction
Uterine cavity-myoma fistulas are more commonly reported after uterine artery embolization rather than myomectomy, occurring as the myoma degenerates and creates a communication with the uterine cavity 6. This is a different entity than utero-peritoneal fistula.
Clinical Bottom Line
When counseling patients about myomectomy risks, utero-peritoneal fistula formation should not be included in routine consent discussions given its extreme rarity. 3, 1, 2 Focus instead on the established complications with measurable incidence rates: uterine rupture risk in pregnancy, fibroid recurrence, standard surgical complications, and fertility outcomes.