A case of vesicouterine fistula with blind vagina following cesarean section for obstructed labor is presented. It was surgically treated by fistulectomy, cervicoplasty and maintenance of bladder and cervical patency by catheterization. Intrauterine synechiae formation was prevented by copper T insertion and oral contraceptive pills. The patient is making uneventful asymptomatic progress planning to conceive.
Case Report: A young lady of 25 years of age with no alive issue was admitted with complaint of cyclical hematuria, amenorrhea, lower abdominal pain and secondary infertility for three years. Five years ago she had an emergency cesarean section following obstructed labor, delivering a dead baby. It was followed by continuous incontinence of urine and was diagnosed as a case of vesicovaginal fistula which was repaired one year later. According to the patient she remained well for one year but developed amenorrhea, cyclical hematuria for the last 3 years. On clinical examination she was a healthy looking young lady. Her blood pressure was 120/80 mmHg, pulse 90/min. Her systemic examination revealed no abnormality. On specific examination, vulva was healthy looking, vagina was short and blind, cervix could not be visualised and the uterus was of 10 weeks size. Her hemoglobin was 12.4 gm%, Urine examination revealed RBC+++and urinary proteins+1. The blood sugar, urea and serum creatinine levels were normal. On pelvic sonogram, uterus was bulky measuring 7.7x4.3x6.5 cms with fluid in the endometrial cavity. IVP was unremarkable. On cystoscopy bladder had a trabaculated outline with narrow neck. Both ureteric orifices were hyperemic. Another orifice was visualised near the right ureteric orifice. Ureteric catheter was passed through it for fistulography which showed opacification outside the bladder. After complete evaluation surgery was planned through abdominopelvic route. Fistulectomy was done via transperitoneal approach. Cervicoplasty was done by blunt dissection through uterine cavity. A small amount of old blood was aspirated from the cavity. A patent canal was thus established followed by insertion of self-retaining Foleys catheter No. 12. Proline marker sutures were applied around the newly formed cervix. Uterus was stitched and abdominal cavity closed. Bladder was drained by Foleys catheter for 21 days.
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