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CASE REPORT
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 159-160
 

Uretero-sigmoid fistula - a rare complication of vaginal hysterectomy


Department of Urology and Radiology, Trivandrum Medical College, Trivandrum, India

Correspondence Address:
A S Albert
Department of Urology, Trivandrum Medical College, Trivandrum (Kerala) - 695 011
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Ureterosigmoid Fistula; Vaginal Hysterec-tomy


How to cite this article:
Albert A S, Chacko SA, Saju P R, Mathew G. Uretero-sigmoid fistula - a rare complication of vaginal hysterectomy. Indian J Urol 2002;18:159-60

How to cite this URL:
Albert A S, Chacko SA, Saju P R, Mathew G. Uretero-sigmoid fistula - a rare complication of vaginal hysterectomy. Indian J Urol [serial online] 2002 [cited 2019 May 25];18:159-60. Available from: http://www.indianjurol.com/text.asp?2002/18/2/159/37625



   Case Report Top


A 50-year-old lady who had undergone vaginal hyster­ectomy for prolapse uterus, developed urine leak per vaginum two weeks after surgery which subsided after a few days. Subsequently she started passing clear fluid per rectum along with normal voiding. Urine culture revealed a heavy mixed bacterial growth. Renal function tests in­cluding electrolyte estimations were normal. Ultrasonog­raphy showed right-sided hydroureteronephrosis without any mass or fluid collection in the pelvis. An intravenous urogram showed a right-sided hydroureteronephrosis and normal bladder with contrast entering the sigmoid colon and rectum, confirming the diagnosis of ureteroenteric fis­tula [Figure - 1],[Figure - 2]. Cystoscopy revealed normal bladder mucosa with absence of ureteric efflux on the right side. The site of fistula above the rectosigmoid junction could be visualised on sigmoidoscopy. On exploratory laparo­tomy, the dilated right ureter could be traced to the site of fistula above the rectosigmoid junction. A left-over broad ligament fibroid was dissected out and excised. The ure­ter was divided at the site of fistula, the distal end ligated and proximal end reimplanted into the bladder. The pa­tient had an uneventful postoperative period with no rec­tal or vaginal urine leak. Relief of obstruction to right kidney was demonstrated on follow-up ultrasonography.


   Comment Top


Ureteral injury is less common during vaginal hyster­ectomy than abdominal hysterectomy with an overall re­ported incidence varying from 0.5-3%. [1] Ureteroenteric fistula is a rare occurrence usually caused by inflamma­tory bowel disease or surgical procedures in the presence of infection, malignancy, hematoma or prior radiation. [2] Uretero-sigmoid fistula following vaginal hysterectomy has not been reported so far. In the above case, it may be attributed to a difficult vaginal hysterectomy due to the presence of dense adhesions in the parameterium causing excessive bleeding during dissection, distortion of anatomy by the broad ligament fibroid and a long redundant loop of sigmoid colon forming an enterocoele, leading to inad­vertent ureteric and sigmoid injury ultimately resulting in a uretero-sigmoid fistula.

 
   References Top

1.Donovan AJ, Ragibson R. Identification of ureteral injury during gynaecologic operation. Am J Obstet Gynecol 1973; 116: 793.  Back to cited text no. 1    
2.Velagapudi SRC, Pollack HM, Weiss JP. Acquired fistulae of the urinary tract. AUA Update 1993; 12: 138-143.  Back to cited text no. 2    


    Figures

  [Figure - 1], [Figure - 2]



 

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