Indian Journal of Urology
CASE REPORT
Year
: 2002  |  Volume : 18  |  Issue : 2  |  Page : 177--179

Vesicocutaneous fistula associated with osteomyelitis of pubic bone - a rare delayed complication of ovarian tumour surgery


Tejanshu P Shah, Kirtipal N Visana, Himanshu R Shah, Prakash Ranka, Rajesh R Chaudhary 
 Department of Urology and Transplantation, Institute of Kidney Disease and Research Centre, Civil Hospital, Ahmedabad, India

Correspondence Address:
Tejanshu P Shah
Department of Urology and Transplantation, Institute of Kidney Disease and Research Centre, Civil Hospital, Ahmedabad
India




How to cite this article:
Shah TP, Visana KN, Shah HR, Ranka P, Chaudhary RR. Vesicocutaneous fistula associated with osteomyelitis of pubic bone - a rare delayed complication of ovarian tumour surgery.Indian J Urol 2002;18:177-179


How to cite this URL:
Shah TP, Visana KN, Shah HR, Ranka P, Chaudhary RR. Vesicocutaneous fistula associated with osteomyelitis of pubic bone - a rare delayed complication of ovarian tumour surgery. Indian J Urol [serial online] 2002 [cited 2020 Aug 10 ];18:177-179
Available from: http://www.indianjurol.com/text.asp?2002/18/2/177/37637


Full Text

 Introduction



Vesicocutaneous fistula is an uncommon condition. Here we present a case report of vesicocutaneous fistula asso­ciated with osteomyelitis of pubic bone. Interestingly this patient is having no history of urinary bladder surgery, orthopaedic surgery, any trauma or tuberculosis.

 Case Report



A 65-year-old female presented with persistent watery discharge from medial part of left thigh following exci­sion of swelling in the left thigh before eight months. Pa­tient had undergone difficult oopherectomy for large left ovarian tumour 40 years back. Patient also had history of occasional burning micturition and frequency of urine. On examination, there was a linear scar on the medial com­partment of left thigh [Figure 1] with persistent watery dis­charge from opening in its caudal part. There was a infraumbilical midline scar in the abdomen. Pervaginal examination was normal. After giving oral pyridium wa­tery discharge became yellowish-orange indicating urinary fistula.

On investigation, renal function test was normal and urine analysis showed 10 to 20 pus cells per high power­field. Ultrasound abdomen was suggestive of absent ovary on left side with normal kidneys and bladder. In plain X­ray pelvis, there was a osteolytic lesion in pubic symphy­sis region [Figure 2]A. Intravenous pyelogram was suggestive of normally excreting kidneys with normal ureter and blad­der. In voiding cystourethrography, bladder capacity was normal with no extravasation of dye. Fistulogram revealed fistulous tract extending from medial part of left thigh, traversing the pubic bone and proximally communicating with the bladder [Figure 2]B. On cystoscopy, urethra and blad­der neck region was normal. Both ureteric orifices were normal. Methylene blue dye when injected from the fistu­lous opening, it could be seen coming from left anterola­teral wall of bladder 2.5 cm away from left ureteric orifice from a mucosal irregularity.

Patient was subjected to the excision of the fistulous tract with removal of necrotic bone tissue and proximal communication with the bladder was excised and bladder closed with 2-0 polygycolic acid in two layers. Cavity which remained after removal of necrotic bone tissue was filled by omentum. Postoperative period was uneventful and perurethral catheter was removed on the 15 th postop­erative day. Histopathological examination was sugges­tive of chronic nonspecific inflammation of the fistulous tract with osteomyelitis of pubic bone and no evidence of granulomatous infection.

 Discussion



Vesicocutaneous fistula is usually seen following uri­nary bladder surgery, radiotherapy, arthroplasty, tubercu­losis and following trauma. In absence of such history, osteomyelitis of pubic bone associated with vesicocutaneous fistula is rare. In this case, probably injury to the periosteum of the pubic bone by inadvertent needle prick during the previous pelvic surgery may be the cause for the osteomyelitis of the pubic bone which later on involved the bladder and track down in thigh to form a urinoma, which after excision of thigh swelling presented as vesico­cutaneous fistula. To our knowledge, we report the first case of vesicocutaneous fistula associated with osteomy­elitis of pubic bone having cutaneous opening in mid-thigh region, presenting 40 years after ovarian tumour surgery.[3]

References

1Gallmetzer J. Gozzi C, Herms A. Vesicocutaneous fistula 23 years after hip arthroplasty: A case report. Urologia Internationalis. 1999; 62: 180-182.
2Lau KG. Cheng C. A case report - delayed vesicocutaneous fistula after radiation therapy for advanced vulvar cancer. Ann Acad Med 1998: 27: 705-706.
3Schneider HJ, Mufti GR. Hematuria and vesicocutaneous fistula after hip surgery : Letter. Br J Urol 1997; 80: 971.