Laparoscopic Cervical Cerclage Band Erosion into the Rectal Lumen Complicated by Recto-Uterine Fistula: A Case Report.

BACKGROUND: Laparoscopic abdominal cervical cerclage (LACC) is a well-established intervention for cervical insufficiency. Long-term complications involving delayed band migration and erosion into adjacent viscera are exceptionally rare; the most frequently reported site is the urinary bladder. To the best of our knowledge, complete erosion into the intestinal lumen has not been previously reported. This report describes a case of complete cerclage band erosion into the rectal lumen, later complicated by recto-uterine fistula formation, and highlights the associated diagnostic and management challenges. CASE: A 44-year-old asymptomatic woman with prior LACC presented for elective band removal. Preoperative evaluation, including pelvic ultrasound, was unrevealing. During laparoscopy, two cerclage bands were found entirely within the rectal lumen, necessitating unplanned rectal repair and diverting transverse colostomy. Three months later, pre-colostomy reversal imaging revealed a recto-uterine fistula. A multidisciplinary team recommended delayed surgical repair; the patient opted for conservative management. CONCLUSION: To the best of our knowledge, this case represents the first report of complete transmural erosion of an LACC band into the rectum with subsequent recto-uterine fistula formation. This case demonstrates that cerclage removal in patients with complex surgical histories warrants careful preoperative planning and multidisciplinary preparedness. Given the extreme rarity of this complication, the decision regarding elective cerclage removal should be individualized.