Fistula formation after implanting an ePTFE membrane. A case report.

BACKGROUND

Expanded polytetrafluoroethylene (ePTFE) membranes have been used successfully as permanent implants to prevent adhesions after gynecologic surgery. Fistulization involving such an implant has not been reported previously.

CASE: A 27-year-old woman had micturition problems and pain four years after a myomectomy and implantation of an ePTFE membrane. Laparotomy revealed that the membrane was partly inserted into a hole in the anterior bladder wall, close to the vesicouterine pouch. The membrane was removed and the fistula repaired. Pathologic studies of the specimen showed multispecies bacterial contamination.

CONCLUSION

The fistula may have originated with ischemia at the vesicouterine fold caused by the suture in the corner of the ePTFE membrane. This led to intussusception of the prosthesis. The hole that was created expanded, and pelvic inflammatory disease probably produced the local sepsis. In patients with posterior or fundal uterine incisions for myomectomy, the ePTFE membrane is a useful permanent adhesion barrier in an area at substantial risk of adhesion formation. In cases using anterior incisions, however, in which the membrane may be fixed close to the vesicouterine fold, surgeons should consider removing the prosthesis after peritoneal healing has occurred.