1/20. Sonographic diagnosis of vesicouterine fistula.Vesicouterine fistula is one of the least common types of urogenital fistula, accounting for only 1-4% of all cases. We report a case of vesicouterine fistula after vacuum delivery in a woman with a history of a previous cesarean section. The 29-year-old woman was hospitalized due to continuous serosanguinous vaginal leakage and hematuria. Transvaginal sonography demonstrated the presence of a fistulous tract between the uterus and the bladder. cystoscopy demonstrated a small opening in the posterior bladder wall and a cystogram revealed a fistulous tract between the posterior portion of the bladder and the uterine cavity. Since the patient could not tolerate her symptoms, we decided to close the fistulous tract surgically. The fistulous tract was excised and the bladder and uterus were closed primarily. The bladder was drained with a Foley catheter for 12 days and subsequent follow-up of the patient has demonstrated urinary continence.- - - - - - - - - - ranking = 1keywords = uterus (Clic here for more details about this article) |
2/20. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature.Herein we report on 1 more case of vesicouterine fistula following cesarean section with review and update of the literature concerning this unusual topic. The disease presented with vaginal urinary leakage, cyclic hematuria and amenorrhea. The fistula was successfully repaired by delayed surgery. Actually, all over the world the prevalence of the disease is increasing for the frequent use of the cesarean section. Fistulas may develop immediately after a cesarean section, manifest in the late puerperium or occur after repeated procedures. Spontaneous healing is reported in 5% of cases. Vesicouterine fistulas present with vaginal urinary leakage, cyclic hematuira (menouria), amenorrhea, infertility, and first trimester abortions. The diagnosis is ruled out by showing the fistulous track between bladder and uterus as well as by excluding other more frequent urogenital fistulas. The disease treatment options include conservative treatment as well as surgical repair. Rarely, patients refuse any kind of treatment because of the benignity of symptoms and prognosis of the disease. Conservative management by bladder catheterization for at least 4-8 weeks is indicated when the fistula is discoveredjust after delivery since there is good chance for spontaneous closure of the fistulous track. Hormonal management should be tried in women presenting with Youssef's syndrome. Surgery is the maninstay and definitive treatment of vesicouterine fistulas after cesarean section. patients scheduled for surgery should undergo pretreatment of urinary tract infections. Surgical repair of vesico-uterine fistulas are performed by different approaches which include the vaginal, transvesical-retroperitoneal and transperitoneal access which is considered the most effective with the lowest relapse rate. Recently, laparoscopy has been proposed as a valid option for repairing vesicouterine fistulas. The endoscopic treatment may be effective in treating small vesicouterine fistulas. The pregnancy rate after repair is 31.25% with a rate of term deliveries of 25%. The disease may be prevented by emptying the bladder as well as by carefully dissecting the lower uterine segment. It is advisable that after vesicouterine fistula repair delivery should be performed by repeating a cesarean section since the risk of fistula recurrence. Usually, vesicouterine fistulas are diagnosed postoperatively. As a result, at least 95% of patients will undergo another operation for repairing the fistula. In the meantime they are bothered by related symptoms which impair their quality of life. As far as we are concerned intraoperative diagnosis is the gold standard in detecting vesicouterine fistulas for allowing immediate repair. We propose intraoperative sonography by the transvaginal (or transrectal) route for the Foley transurethral catheter producing bloody urine, for suspecting bladder injury while dissecting the uterine lower segment and for monitoring patients who already had had vesicouterine fistula repair. As a result patients will avoid the familial and social problems related to the disease as well another operation. Moreover, ultrasound Doppler examination may help in better investigating and understanding the pathophysiology of vesicouterine fistulas.- - - - - - - - - - ranking = 0.5keywords = uterus (Clic here for more details about this article) |
3/20. Colouterine fistula complicating diverticulitis: a case report and review of the literature.Colouterine fistula, secondary to diverticulitis, is an extremely rare complication, and only few cases have been reported in the literature. We report the case of 76-year-old woman, who presented with vaginal discharge over a three-month period. Pelvic examination and laboratory investigations suggested a colouterine fistula, that was confirmed by non-invasive imaging. Surgical treatment was a one-stage, en bloc resection of the uterus and sigmoid colon. In the presence of severe inflammatory reaction or paracolic abscess, a two-stage procedure should be safer. Otherwise, a one-stage procedure, en bloc resection of the uterus and sigmoid colon is preferred, as we cannot rule out a malignancy prior to surgery.- - - - - - - - - - ranking = 1keywords = uterus (Clic here for more details about this article) |
4/20. Colouterine fistula complicating diverticulitis: charcoal challenge test aids in diagnosis.fistula formation between a segment of colon and the uterus is an unusual complication of diverticulitis; only 17 cases have been reported in the world literature. We describe a 69-year-old woman with a colouterine fistula secondary to diverticulitis. She presented with a malodorous vaginal discharge that grew multiple enteric organisms on culture. A barium enema revealed colonic diverticula but no fistula tract. Orally administered activated charcoal was seen flowing from the cervical os during a pelvic examination the following day, establishing a diagnosis of colouterine fistula. Pathologic examination of the resected colon and uterus confirmed this diagnosis and determined that diverticulitis was the etiology. From a review of the literature, we conclude that radiographic and invasive procedures cannot be depended upon for diagnosis. Ingestion of activated charcoal may provide a simple, noninvasive approach to the diagnosis of enterouterine fistulas.- - - - - - - - - - ranking = 1keywords = uterus (Clic here for more details about this article) |
5/20. Preoperative diagnosis of colouterine fistula secondary to diverticulitis by sonohysterography with contrast medium.Colouterine fistulae secondary to sigmoid diverticulitis are unusual. methods for diagnosis remain to be established. We report a case with a colouterine fistula in which sonohysterography detected the flow of ultrasound contrast medium between the uterine cavity and the sigmoid colon through the posterior uterine wall, thus confirming the diagnosis. The diagnosis was further substantiated by a charcoal challenge test. The patient underwent en bloc resection of the uterus, fallopian tubes, ovaries and sigmoid colon, the organs involved with diverticulitis. This is the first report to describe a colouterine fistula successfully diagnosed by sonohysterography using ultrasound contrast medium.- - - - - - - - - - ranking = 0.5keywords = uterus (Clic here for more details about this article) |
6/20. Hysterosalpingographic diagnosis of Crohn's disease. A case report.A woman presented with abdominal pain, weight loss and a pelvic mass. At the time of laparotomy she had a lower abdominal abscess from perforation of the ileum. Two years later she returned with a tender uterus and purulent cervical discharge. A hysterosalpingogram demonstrated an uteroileal fistula secondary to Crohn's disease, and the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy.- - - - - - - - - - ranking = 0.5keywords = uterus (Clic here for more details about this article) |
7/20. Repair of uterocutaneous fistula.BACKGROUND: Uterocutaneous fistula is a rare condition that may be difficult to manage. CASE: A young woman who underwent surgical intervention for cryptomenorrhea 3 years ago developed menstrual discharge from the abdominal scar. A fistulous tract leading from the infraumbilical midline scar to the uterus was demonstrated on contrast study. Genital examination revealed vaginal agenesis. A vaginoplasty was performed as the first stage. This was followed one year later by excision of the fistulous tract and establishment of cervicovaginal communication. The patient is now menstruating from the vaginal passage. CONCLUSION: This case shows that a stepwise, well-planned, and well-executed procedure can lead to a satisfactory repair of an uterocutaneous fistula.- - - - - - - - - - ranking = 0.5keywords = uterus (Clic here for more details about this article) |
8/20. Ectopic pregnancies due to contralateral fistulas after sterilization by electrocoagulation; case reports.Three cases of post-sterilization tubal pregnancy are discussed. The sterilizations were performed by bipolar electrocoagulation. The location of the pregnancy was distal to the site of sterilization. There was no continuity between the segment containing the ectopic pregnancy and the uterus. spermatozoa reached the site of fertilization via a tuboperitoneal fistula. The existence of the fistulas was confirmed by a methylene blue test. In two cases fistulas existed on the contralateral side to the ectopic pregnancy. In the third case, bilateral fistulas were found. So, on performing a salpingectomy for ectopic pregnancy after sterilization failure, we have to be aware of contralateral fistulas. Also good understanding of the mechanism of extra-uterine pregnancy secondary to transperitoneal migration of spermatozoa is important when doing conservative tubal surgery.- - - - - - - - - - ranking = 0.5keywords = uterus (Clic here for more details about this article) |
9/20. Successful pregnancy after surgical repair of vesico-uterine fistula.After a survey of the pertinent literature, a brief account of the signs and symptoms, diagnosis and therapy of vesico-uterine fistula is given and two cases are reported. In the first case hysterectomy had to be done because tissue destruction was too extensive for organ saving surgery. In the second case the extent of the lesion was compatible with preservation of the uterus. Healing was smooth, and free from complications in both cases. In Case 2, five years after operation the patient gave birth to a healthy female child of 3750 g weight. It is emphasized that in surgical repair of vesico-uterine fistulae preservation of the uterus should be sought.- - - - - - - - - - ranking = 1keywords = uterus (Clic here for more details about this article) |
10/20. Colouterine fistula secondary to diverticulitis.Colouterine fistula complicating diverticulitis is rare. Our experience with two patients, one with chronic vaginal discharge and the other with acute overwhelming sepsis, emphasizes the wide spectrum of clinical presentations that may accompany this entity. In patients with chronic symptoms, surgery is indicated to forestall further local infectious complications, and a single-stage sigmoid resection without hysterectomy may be adequate. If malignancy cannot be excluded, a single-stage en bloc resection of the uterus and colon is the procedure of choice. hysterectomy may also be mandatory to extirpate a nidus of acute infection. When severe local inflammation or obstruction mandate urgent operation, a two-stage procedure involving resection and end colostomy, followed by reanastomosis at a later time, is safest and most effective.- - - - - - - - - - ranking = 0.5keywords = uterus (Clic here for more details about this article) |
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