Year : 2002 | Volume
: 18 | Issue : 2 | Page : 159--160
Uretero-sigmoid fistula - a rare complication of vaginal hysterectomy
AS Albert, Sara Ammu Chacko, PR Saju, George Mathew
Department of Urology and Radiology, Trivandrum Medical College, Trivandrum, India
A S Albert
Department of Urology, Trivandrum Medical College, Trivandrum (Kerala) - 695 011
|How to cite this article:|
Albert A S, Chacko SA, Saju P R, Mathew G. Uretero-sigmoid fistula - a rare complication of vaginal hysterectomy.Indian J Urol 2002;18:159-160
|How to cite this URL:|
Albert A S, Chacko SA, Saju P R, Mathew G. Uretero-sigmoid fistula - a rare complication of vaginal hysterectomy. Indian J Urol [serial online] 2002 [cited 2021 Aug 4 ];18:159-160
Available from: https://www.indianjurol.com/text.asp?2002/18/2/159/37625
A 50-year-old lady who had undergone vaginal hysterectomy for prolapse uterus, developed urine leak per vaginum two weeks after surgery which subsided after a few days. Subsequently she started passing clear fluid per rectum along with normal voiding. Urine culture revealed a heavy mixed bacterial growth. Renal function tests including electrolyte estimations were normal. Ultrasonography showed right-sided hydroureteronephrosis without any mass or fluid collection in the pelvis. An intravenous urogram showed a right-sided hydroureteronephrosis and normal bladder with contrast entering the sigmoid colon and rectum, confirming the diagnosis of ureteroenteric fistula [Figure 1],[Figure 2]. Cystoscopy revealed normal bladder mucosa with absence of ureteric efflux on the right side. The site of fistula above the rectosigmoid junction could be visualised on sigmoidoscopy. On exploratory laparotomy, the dilated right ureter could be traced to the site of fistula above the rectosigmoid junction. A left-over broad ligament fibroid was dissected out and excised. The ureter was divided at the site of fistula, the distal end ligated and proximal end reimplanted into the bladder. The patient had an uneventful postoperative period with no rectal or vaginal urine leak. Relief of obstruction to right kidney was demonstrated on follow-up ultrasonography.
Ureteral injury is less common during vaginal hysterectomy than abdominal hysterectomy with an overall reported incidence varying from 0.5-3%.  Ureteroenteric fistula is a rare occurrence usually caused by inflammatory bowel disease or surgical procedures in the presence of infection, malignancy, hematoma or prior radiation.  Uretero-sigmoid fistula following vaginal hysterectomy has not been reported so far. In the above case, it may be attributed to a difficult vaginal hysterectomy due to the presence of dense adhesions in the parameterium causing excessive bleeding during dissection, distortion of anatomy by the broad ligament fibroid and a long redundant loop of sigmoid colon forming an enterocoele, leading to inadvertent ureteric and sigmoid injury ultimately resulting in a uretero-sigmoid fistula.
|1||Donovan AJ, Ragibson R. Identification of ureteral injury during gynaecologic operation. Am J Obstet Gynecol 1973; 116: 793.|
|2||Velagapudi SRC, Pollack HM, Weiss JP. Acquired fistulae of the urinary tract. AUA Update 1993; 12: 138-143.|