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Case: A 40-year-old woman presented with secondary infertility after surgical management of miscarriage. A hysterosalpingogram (HSG) and magnetic resonance imaging identified a large Caesarean scar defect with fistulation into the peritoneal cavity. She subsequently underwent laparoscopic repair of the uteroperitoneal fistula. Outcome: A repeat HSG three months post-operatively confirmed successful closure of the fistula. 18 months postoperatively she successfully spontaneously conceived with twins. Despite demise of one twin in early pregnancy, she underwent an uncomplicated Caesarean section at term. At the time of writing, she is three years post-repair, remains asymptomatic, and has now completed her family. Conclusion: We demonstrate herein an effective laparoscopic surgical repair of a uteroperitoneal fistula and report an excellent clinical outcome including successful live birth. With only 15 cases reported in the literature to date, it is unsurprising there is lack of consensus and little guidance with regards to their management. Following review of the literature, we propose a management algorithm to help guide and facilitate the management of such cases in the future. Given the preponderance to impact women of reproductive age, and the fact that more than a third affected are nulliparous, consideration of fertility sparing surgical techniques is essential.

Laparoscopic Repair of Utero-Peritoneal Fistula; A Fertility Preserving Approach with Subsequent Live Birth