Bladder perforation and development of a vesico - vaginal fistula following laparoscopic assisted vaginal hysterectomy: case report

Abstract

Bladder injury with subsequent development of a Vesico-Vaginal Fistula following a Laparoscopic Assisted Vaginal Hysterectomy is reported. The injury was not recognised intra - operatively or in the immediate post-operative period. On the third post-operative day, the patient complained of abdominal distention, and a reduced urine output was noted. There was no haematuria. Conservative management by continuous bladder drainage was not successful. A low-pressure cystogram done on day eight revealed a bladder leakage. On day 21, a repeat low-pressure cystogram showed a vesico-vaginal fistula. A successful transvesical repair by laparotomy was undertaken on day 23. The possible mechanisms of injury, prevention and the principles of management are discussed.

East African Medical Journal Vol. 82(9) 2005: 482-485