Uterine Cavity–Myoma Fistula after Hysteroscopic Myomectomy Mimicking Uterine Perforation at Hysterosalpingography: Case Report

Fistula formation between the uterine cavity and the cavity of a subserosal myoma was diagnosed at laparoscopy/hysteroscopy in a 39-year-old woman with primary infertility. The patient had undergone 2 previous hysteroscopic resection procedures for removal of a submucosal myoma as part of infertility treatment. Hysterosalpingography demonstrated leakage of contrast medium from the uterine cavity, a characteristic feature of uterine perforation. At hysteroscopy/laparoscopy, a defect was observed in the posterior wall of the uterine cavity with connection to the cavity of a subserosal myoma without any tract to the peritoneal cavity. Laparoscopic myomectomy was performed to repair the uterine wall defect at the site of the fistula. Subsequently, the patient conceived after an office-based gonadotropin cycle therapy and is currently 20 weeks pregnant.