FISTULA FORMATION AFTER IMPLANTING AN EPTFE MEMBRANE - A CASE-REPORT

BACKGROUND: Expanded polytetrafluoroethylene (ePTFE) membranes have be en used successfully as permanent implants to prevent adhesions after gynecologic surgery. Fistulization involving such an implant has not b een reported previously.CASE: A 27-year-old woman had micturition prob lems and pain four years after a myomectomy and implantation of an ePT FE 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 s tudies of the specimen showed multispecies bacterial contamination. CO NCLUSION: The fistula may have originated with ischemia at the vesicou terine fold caused by the suture in the corner of the ePTFE membrane. This led to intussusception of the prosthesis. The hole that was creat ed expanded, and pelvic inflammatory disease probably produced the loc al 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 a nterior incisions, however, in which the membrane may be fixed close t o the vesicouterine fold, surgeons should consider removing the prosth esis after peritoneal healing has occurred.