# A utero-pelvic fistula and pelvic-parasitic myoma by hysteroscopic resection of a recurrent submucosal myoma: a case report

## TL;DR

This case report describes a rare complication where a uterine fistula and pelvic-parasitic myoma developed after hysteroscopic resection of a recurrent submucosal myoma.

## Contribution

The paper highlights a rare clinical scenario involving utero-pelvic fistula and pelvic-parasitic myoma following hysteroscopic myoma resection.

## Key findings

- Recurrent submucosal myoma can breach the uterine serosa, leading to utero-pelvic fistula and pelvic-parasitic myoma.
- Preoperative enhanced MRI is crucial for accurate diagnosis and surgical planning in such cases.

## Abstract

The occurrence of a uterine fistula combined with parasitic myoma formation is rare. We report a case involving a utero-pelvic fistula and a pelvic-parasitic myoma following hysteroscopic resection of a recurrent submucosal myoma.

A 37-year-old woman who had undergone surgery for laparoscopic myomectomy of large uterine fibroids presented with abnormal uterine bleeding (AUB) for over 6 months and 4 years ago. One year ago, the patient returned to the hospital due to abnormal uterine bleeding (AUB); both transabdominal sonography (TS) and dynamic pelvic magnetic resonance imaging (MRI) revealed submucosal myomas that were subsequently removed hysteroscopically. On a subsequent visit, the patient returned for the third time due to recurrent AUB. She eventually underwent a laparoscopic myomectomy of uterine fibroids after transabdominal sonography (TS) detected a uterine myoma, and dynamic pelvic MRI revealed a uterine myoma at the base of the uterus that locally penetrated the uterine serosal surface, as well as a small leiomyoma in the left utero-rectal fossa.

In rare cases, recurring submucosal myoma after hysteroscopic surgery can breach the surface of the uterine serosa, leading to utero-pelvic fistula and pelvic-parasitic myoma. Preoperative enhanced MRI examinations can aid clinicians in choosing appropriate surgical methods, thereby avoiding the risk of misdiagnosis and missed diagnosis.