Fistule vesico cutanée post traumatique

Abstract

We here report the case of a 43-year old motorcyclist who was initially examined in the emergency department for injuries following a road accident with a car. The patient had pelvic trauma with extensive symphyseal disjunction (A). He underwent orthopedic treatment based on weight compensation. During the two weeks immediately following the trauma, patient's evolution was marked by the occurrence of fistulous orifice at the level of the inner right thigh (B) associated with urinary outflow and wounds due to local skin maceration around the fistula. Radiologically, abdominopelvic CT scan at extended injection-to-scan acquisition time showed contrast extravasation laterally, into the bladder and at the level of the right thigh root due to subperitoneal rupture of the bladder (C). Uretrocystography objectified symphyseal disjunction visible on the non-contrast abdominal X-ray film. Moreover, uretrocystography showed fistulous track after uterovesical opacification (D). Standard laboratory tests were normal. Given the subperitoneal rupture of the bladder and the absence of associated lesions, conservative treatment by prolonged bladder drainage with urethral catheter and local care of the fistulous orifice were performed. Patient's evolution was marked by complete drying up of the fistula.