A 33 year-old woman had an emergency caesarean section for retained second twin which was complicated by utero-cutaneous fistula due to red degeneration of intramural fibroid. The utero-cutaneous communication was demonstrated by an examination under anaesthesia using dye test. She then underwent excision of the fistula tract and myomectomy. She recovered well following the surgery. This is the first case of utero-cutaneous fistula where the communication is between the endometrial cavity and skin lesion via a necrotic intramural fibroid following caesarean section. Fistulogram might fail to demonstrate the communication. In highly suspected case, other modalities of investigations could be utilised.