Urinary ascites in late onset of bladder injury post laparoscopic hysterectomy

Abstract

Urinary tract injuries are unfortunate complications of pelvic surgery. With the increasing popularity of minimally invasive surgery, a thorough understanding of electrosurgical instrumentation and their thermal spread is important to reduce patient injuries.The index patient was a 50 year old woman who underwent a supracervical hysterectomy 5 years prior to her presentation with pelvic pain and dysuria. When her symptoms failed to improve despite antibiotic and analgesic therapy, an abdominal CT scan revealed an ovarian cyst and ascites. A subsequent laparoscopy disclosed the presence of a bladder fistula and a diagnosis of urinary ascites was made. The patient then underwent a subsequent bladder fistula repair.Vesicoperitoneal fistulae (VPF) are rare and should be included in the differential diagnosis of the patient with acute onset ascites following gynecologic surgery. This case is the first case report of a VPF occurring 5 years following surgery.

Mesh related vesico-peritoneal fistula presenting with urinary ascites: A case report

“…Dawkins et al reported a case of urinary ascites 5 years after laparoscopic hysterectomy during which a thermal injury was observed in routine intraoperative cystoscopy. 5 Patient underwent bladder decompression for 10 days and CT urography did not reveal any pathology at the 10th postoperative day. 5 years later she presented with the complaints of dysuria and abdominal pain.…”

A vesico-peritoneal fistula in a patient with history of diverticulitis-related colovesical fistula repair: a case report

“…A vesico-peritoneal fistula is a rare condition. [1][2][3][4] Abdullah reported this entity in a 48-year-old female with history of laparoscopic hernia repair with composite mesh three years before the diagnosis. 2 Ooi and Ismail described it in two female patients with emergency cesarean section.…”

“…Although no studies have compared outcomes in surgical management of bladder defect in benign enterovesical fistulas in the long term, closure of the bladder wall does not appear to have different outcomes in the short term. 3 The 5-year interval between etiology and diagnosis could be explained by a urinary bladder diverticulum formation and rupture, adhesions of the fistulous tract limiting leakage, and delayed diagnosis.…”

“…1,2 It is a very rare condition, reported as a long-term complication of mesh-patch hernioplasty and gynecological surgery. [1][2][3][4] Due to a low incidence and scarce reports in literature, a high index of suspicion is needed for diagnosis and treatment, leading to delayed recognition and misdiagnosis. As the fistulous tract develops, urinary ascites causes chronic abdominal pain, elevated serum creatinine levels, and decreased urine output, which could simulate renal failure.…”

“…2 Treatment is controversial, since conservative and surgical procedures have been practiced and reported safe with limited evidence. [1][2][3][4] It is known that acute diverticulitis can often develop complications such as abscess, perforation, obstruction or fistula in 25% of patients. Sixty five percent of diverticulitis-related fistulas are colovesical with no reported incidence of vesico-peritoneal fistulas.…”