A 27-years-old female presented to Motahari University Hospital infertility clinic with primary infertility for 4 years in 2017. She had been referred to the infertility clinic from 1 year after her marriage. The patient had a history of dysmenorrhea and dyspareunia without any unusual bowel disease. Family history for any disease including tuberculosis was negative. Also, her sister had married for 2 years and had a healthy child at the time of presentation. She had a history of laparotomy 3 years ago for left ovarian cystectomy in 2014. A pathologic report for cystectomy was endometriosis. In the post-operation course (2014-2017) she was admitted several times without any medical problem in our infertility clinic. Physical examination revealed a healthy female with no relevant abnormal general or local genital physical findings apart from the scar of previous Pfannenstiel incision. Her husband was clinically normal and all investigations for malefactors of infertility were normal. The last Hysterosalpingogram (HSG) performed under normal sterile procedures using non-ionic contrast (iohexol 300 mg). Following initial injection of about 8 mL of contrast, normal endometrium outline with no filling defect, contrast filled both tubes till fimbrial ends but contrast joined small intestine on the right side and leaked to the peritoneal cavity in the left side (Figure 1). The biochemistry assays revealed a negative result for HIV Ab (ELISA). Tissue specimens for tuberculosis investigation were collected by biopsy but the report was negative. The following of the patient was continued.
After consultation with the patient and her husband, she opted for fistula resection. This carried out successfully by our general surgery department in imam Khomeini university hospital. Closure of enteric fistula performed under general anesthesia in the supine position with lower midline laparotomy incision. Laparotomy revealed many adhesion bands and debris in the pelvic region with fistulous communication between Ileum (60 cm to Ileocecal valve) and right fallopian tube. On the left side, there was much suppurative debris with the destructed tube. Because of strong intestine adhesions to the right fallopian tube, involved segment resected and primary anastomosis performed by our teammates. Finally, because of this strong adhesion and destructed tubes bilateral salpingectomy performed by obstetrics and gynecology teammates. She follows up for infertility problems in an infertility clinic.