Post hysterectomy ureterovaginal fistula

Case contributed by Dr Mohamed Hossam el Deen

Presentation

Excessive watery vaginal discharge after hysterectomy done in other hospital a month ago.

Patient Data

Age: 35 years old
Ultrasound

Urgent trans abdominal ultrasound showing a fluid filled blunt ended pouch representing the residual vaginal part post hysterectomy and the fluid most probably urine content.

Fluoroscopy

IVP showing right ureter with leak of contrast media out and appearance in vagina and pelvic towels. there is also mild dilated renal pelvis, hydronephrosis and ballooning of renal calyces. Oblique and lateral radiography demonstrates a very faint linear contrast that represents a fistulous tract communicating the right ureter and the vaginal vault.

Frontal erect KUB showing surgical clips after hysterectomy. 

Case Discussion

A fistula is a communication between 2 organ sites. Ureterovaginal fistula is a communication tract between the distal ureter and the vagina. The urine from the ureter bypasses the bladder and flows into the vagina. This also results in total or continuous incontinence and back pressure changes in the proximal urinary tract. It is considered a serious complication post hysterectomy or post oophorectomy that requires surgical intervention.

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Case information

rID: 46856
Case created: 20th Jul 2016
Last edited: 28th Jul 2016
Inclusion in quiz mode: Included
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