Case ReportTubacutaneus FistulaPresentant: Kevin ArdiansyahNIM : 11-2013-265Consulant: dr. ohan M !uta"arat #$.%&'#() *A'AKAN)+PA'*M+N* %, %-#*+*'. AN) &.N+C%/%&.Introduction0&yne1olo2ist is 3a4iliar 5ith : vesi1ova2inal6 uretrova2inal6 and re1tova2inal 3istulae.0,istula *u"a1utaneus is rare 1ase 6 no 1ase is re$orted re2ardin2 tu"o1utaneus 3istula.0In this 1ase 6 the 3istula tu"a1utaneusis develo$ed a3ter treatin2 the $elvi1 a"s1ess.0*he 3istula e7tended 3ro4 the ri2ht 3allo$ian tu"e to the ri2ht 2roin alon2 the anato4i1al $ath o3 the round li2a4ent.Case Report0A80 years old 5o4an 5ith 2 $reviousnor4al deliveries $resented to sur2eon at Kin29s Mill !os$ital in a$ril 2013 : : 3-year history o3 inter4ittently dis1har2in2 $ersistent ri2ht 2roin sinus.:*he dis1har2e is $urulent0Past 4edi1al history :/a$aroto4y 3or ru$tured $yosal$hin7 in 2000:'e1urrent a"do4inal $ain in 200; and 2011 &ive antio"ioti1 and o$tion to $elvi1 1learan1e and then the $atient have 1onservative 4ana2e4entCase Report0 +7a4ination: #ur2eonnoted )is1har2in2 sinus o3 the ri2ht 2roin 5< d : !idraadenitis.: C* #ino2ra4 +7tendin2 3ro4 the ri2ht 2roin 1rease to the ri2ht adne7a 5ith the 1ontrasttra1=in2 "ehind uterus and the u$$er va2ina: *hen the $atient re3erred to the 2yne1olo2y tea40 &yne1olo2i1al asses4ent and e7a4ination: !istory 'i2ht illia1 3ossa $ain and 1onstant dis1har2e 3ro4 the ri2ht 2roin sinus.: A"do4inal Midline la$arato4y s1ar and dis1harhin2 ri2ht 2roin sinus.: Pelvi1 'edu1ed 4o"ility o3 the $elvi1 or2an and thi1=enin2 o3 ri2ht adne7al re2ionCase Report0A3ter liaisin2 5ith the sur2eon : *he $lan 4ade 3or la$aroto4y6 ri2ht sal$hin2ooo3ore=to4i6 and e71ition o3 3istulous tra1t : *he $atient 5as in3or4ed re2ardin2 the ris= to ad>e1ent vas1ular stru1tures due to $ro7i4ityo3 the tra1t to the 4a>or "lood vessels.0 May 2? 2018 : the $atient had la$aroto4yunder the >oint 1are o3 the 2yne1olo2ist and sur2eon.: 'esult ::Nor4al le3t tu"e and ovary 5hi1h5as atta1hed to le3t $elvi1 side 5all.: *he uterus 5as nor4al and she had nor4alri2ht ovary and ri2ht $yosal$hin7 Case Report0'esult:*he 3istulous tra1t 5as 1o44uni1atin2 to the 1ornual end o3 the 3allo$ian tu"e $osterior to the round li2a4ent@ it then 3ollo5ed the $ath o3 the round li2a4ent o$enin2 at the level o3 the in2uinal rin2 in the ri2ht 2roinCase Report 0%$eration $ro1edure:'i2ht sal$hin2e=to4i5as $er3or4ed:'i2ht round li2a4ent5as divided near the ri2ht 1ornual end o3 the uterus@ a ri2ht 2roin 3istuloustra1t o3 3 14 5as e71ised.0!isto$hatolo2y :Pyosal$hin7 5ith the 3eatures o3 1hroni1 and a1ute in3la44ation 5ith 4i1roa"s1esses and 3istulous tra1t sho5in2 in3la44atory 2ranulation tissue 5ithout eviden1e o3 4ali2nan1y.0*he $atient 5as dis1har2ed ho4eon the 3rd $ost o$erativedayCase Report0*hen the $atient 5as read4itted on the 6th $ost o$erativeday 5ith headache.0*hen she 5as seen"y anesthetist5ho treated her 5ith a "lood $at1h 3or $ostdural heada1he.0*he $atient 4ade 2ood $osto$erative re1overy 3ollo5ed "y the "lood$at1h and she 5as dis1har2ed ho4e on the ;th $osto$erative day.0; 5ee=s later the $atient revie5ed in 1lini1 6 she had 4ade a 2ood re1overy5ith1o4$letely healed ri2ht 2roin5ound and la$aroto4y s1arDiscussion0*he 1o44uni1ation "et5een the 3allo$ian tu"eand s=in isvery rare.0+tiolo2y :%"stetri1 sur2i1al:Pelvi1 in3la44atory disease:+ndo4etriosis:*u"er1ulosis:Pelvi1 irradiation:In3la44atory "o5el disease:And $elvi1 sur2eryDiscussion0In our 1ase:*he 3istulous tra1t : 3ollo5in2 the $ath o3 the round li2a4ent and it has develo$ed a3ter re1urrent e$isodes o3 $elvi1 in3la44atory disease0!#& 6 ultrasound6 C*6 and M'I are investi2ation 4odalities o3 1hoi1e 0*he treat4entde$ends on the a2e o3 the $atient and the3ertility o$tion o3 the 5o4en.0,istulas to the 3allo$ian tu"e are rare and their 4ana2e4ent is not very 5ell des1ri"edDiscussion0Most studies advo1ate 3istula rese1tionand sal$in2e=to4y as the only 3easi"le 4ethod o3 treatin2this rare disease to $revent the o11uren1e o3 e1to$i1 $re2nan1y.Conclusion 0*u"o1utaneus 3istule is rare0their 4ana2e4ent is not 5ell des1ri"ed in the literature.0#al$in2e1to4y6 rese1tion o3 3istulous tra1t6 and treatin2 the underlyin2 1ause are the treat4ent o3 1hoi1e.0+arly dia2nosisand treat4ent o3 these $atient are essential3or avoidin2lon2 ter4 1o4$li1ationConflict of interest0*he authors de1lare that they have no 1on3li1t o3 interests.TERIMA KASIH