Presentation
CT for lung cancer staging. No urogenital symptoms. No history of abdominal surgery. Nine previous vaginal deliveries without complications.
Patient Data
Renal excretory phase shows excretion of contrast into the vagina, without identification of fistulous track. Urinary bladder demonstrating two diverticula on lateral walls. No ureteral abnormalities.
Additional findings include right Bosniak I renal cysts, aorto-iliac atheromatosis, degenerative vertebral disease and colonic diverticular disease.
Case Discussion
Vesico-vaginal fistula usually occurs as a complication of childbirth or gynecologic procedure, namely hysterectomy.
Another risk factors include trauma, radiotherapy, pelvic inflammatory disease, diabetes and neoplasms of the bladder and cervix 1.
Our pacient had no history of gynecologic procedures, but had nine previous vaginal deliveries. She was also insulin dependent diabetic, with several microvascular complications.
Delayed contrast-enhanced CT shows excretion of intravenous contrast into the vagina in about 60% of the cases. Air or fluid in the vagina may also be present 2. The fistulous track may or may not be visible.