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
Tejanshu P Shah
Department of Urology and Transplantation, Institute of Kidney Disease and Research Centre, Civil Hospital, Ahmedabad
|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 2021 Jun 19 ];18:177-179
Available from: https://www.indianjurol.com/text.asp?2002/18/2/177/37637
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.
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.
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.
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