Abstract              Background: Uterine fistulae commonly occur between the uterus and bladder or bowel (uterovesical or uterocolonic), as a sequelae of inflammatory / infective conditions, or following surgeries. Uterocutaneous fistula is an infrequently seen condition, which usually develops as a complication following caesarean section or pelvic surgeries. Rare causes of Uterocutaneous fistulae include endometriosis, infection and intra uterine contraceptive devices. Case presentation: We report here a case of uterocutaneous fistula with scar endometriosis, which was diagnosed preoperatively on MRI. A 34 year old Para 2, Living 2, previous 2 LSCS patient with no comorbidities, presented with complaints of pain and swelling at the LSCS scar site for the past two years, associated with serous and bloody discharge from the scar on and off for the past two months. On examination, her vitals were stable. Pfannensteil incision was noted with a small swelling at the scar site. There was associated serous and bloody discharge from the swelling. Ultrasound evaluation revealed normal endometrial thickness with the endometrial cavity seen communicating with a complex hypoechoic collection anteriorly. Subsequent MRI not only diagnosed the presence of scar endometriosis, but also revealed the presence of a hitherto unsuspected uterocutaneous fistula extending through the endometriotic tissue. These findings were confirmed at surgery. The patient underwent hysterectomy, bilateral salphingectomy and excision of the uterocutaneous fistula with anterior abdominal wall mesh repair. Histopathological examination proved the diagnosis of endometriosis. Postoperatively, the patient was given GNRH analogues for 3 months. Conclusion: Accurate preoperative diagnosis of a complex entity like uterocutaneous fistula with scar endometriosis using a non invasive imaging modality [MRI] helps in optimal and appropriate patient management. Correct preoperative diagnosis in our patient facilitated good surgical outcome with an uneventful post operative period and resolution of symptoms on follow up.

Key Words: Uterocutaneous fistula, Scar endometriosis, Magnetic resonance imaging [MRI].