PMC9666701_01
(A) The fistulous end of the anterior cervix in hysteroscopy; (B) the fistulous end of the bladder in cystoscopy; (C) hematosalpinx of both fallopian tubes in laparoscopy; (D) the identification of the fistulous end of the cervical and uterine canal by bougie, as well as bladder fistulous end in laparoscopy; (E) the reconstruction of the bladder and the uterus in laparoscopy; (F) intrauterine adhesions in hysteroscopy.
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F1
A huge defect was discovered at the 12 o'clock position in the cervical canal when the scope was moved forward (Figure 1A). A contracted scar filled with decayed tissue was found on the posterior bladder wall by cystoscopy (Figure 1B), measuring approximately 10 mm in diameter. Both fallopian tubes exhibited hematosalpinx (Figure 1C). Next, the uterus was reconstructed by two layers of interrupted sutures (Figures 1D,E). Multiple dense adhesions were observed on both sides of the uterine cavity, and the adhesions accounted for 1/3-2/3 of the area of the uterine cavity (Figure 1F).
Graphic representation of the fistulous tract.
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F2
The adhesion was released carefully, and the scar was removed; finally, the fistulous tract was ended by the posterior wall of the bladder and the anterior cervix of the uterus (Figure 2) after the complete exposure of the uterus and bladder.
(A) The anastomotic stoma of the uterine isthmus and cervix; (B) normal uterine cavity.
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F3
In addition, no obstruction or adhesion was found in the cervical canal (Figure 3).