Gynaecological gastrointestinal crossroad: rectouterine fistula presenting as menochezia

Recto-uterine fistula is an exceptionally rare clinical entity characterised by an abnormal communication between the rectum and uterine cavity. We report the case of a young woman who presented with cyclical passage of blood per rectum coinciding with menstruation-a symptom known as menochezia. Her symptoms began approximately 2 weeks after undergoing a dilatation and curettage procedure performed for second-trimester miscarriage. MRI revealed a fistulous tract of 5 mm between the posterior uterine wall and anterior rectal wall, confirming the diagnosis. Laparoscopic and hysteroscopic evaluation followed by minimally invasive surgical repair successfully resolved the fistula. This case highlights the importance of considering recto-uterine fistula in patients with post-procedural menochezia and underscores the value of MRI in diagnosis and laparo-hysteroscopic surgery as an effective treatment approach.