Tubal malformation with primary vesico-tubal fistula
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IMAGES IN UROGYNECOLOGY
Tubal malformation with primary vesico-tubal fistula Fang Li 1,2 & Fan Xu 1,3 & Zhong Lin 2 Received: 15 January 2020 / Accepted: 20 March 2020 # The International Urogynecological Association 2020
Keywords Tubal malformation . Primary vesicle-fallopian tube fistula
A 27-year-old infertile female received hysterosalpingo contrast sonography, which showed a slender tube connecting the right-hand-side fallopian tube and the bladder (Fig. 1). Her history hinted no menouria, cyclical haematuria, urinary incontinence or abnormal vaginal secretions. Thereafter, laparoscopy, hysteroscopy and cystoscopy examinations were performed, and results demonstrated a supratrigonal fistula of 1–2 mm diameter (Figs. 2 and 3). We separated the adhesion and cut open the fistula to reveal the fistulous track. The bladder was then sutured in a single layer with 3–0 polyglactin intracorporeal sutures. In the meantime, a bilateral tubal resection was performed for IVF treatment. We found that each fallopian tube had two lumens under the laparoscopy and microscope (Fig. 4). The patient suffered no complications after the operation, and 8 days later, the uroscan showed a normal situation.
Fang Li and Fan Xu contributed equally to this work. * Zhong Lin [email protected] 1
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, People’s Republic of China
2
Department of Obstetrics and Gynecology, Liuzhou Maternal and Child Health Care Hospital, Liuzhou, Guangxi 545000, People’s Republic of China
3
Department of Obstetrics and Gynecology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical University, Nanchong, Sichuan 637000, People’s Republic of China
Genitourinary fistula is one of the most common postoperative complications. A large case series from the Mayo Clinic showed the cause of fistula formation was gynecologic surgery (mostly hysterectomy) 82%, obstetrics (mostly dystocia) 8%, radiation exposure 6% and trauma 4% [1]. However, vesico-adnexal fistula was rarely reported. On literature search, we found only four cases of vesico-adnexal fistula and all of them were secondary to infection [2]. Among the four cases, two were caused by pelvic endometriosis and the other two were infections after pelvic surgery. All cases underwent resection of the mass with abscess, fistula and partial cystectomy. However, in this case, there was no previous history of pelvic infection, surgery or endometriosis. Meanwhile, fallopian tube malformation was observed and both fallopian tubes were found with two tube lumens. In a word, evidence has made this case the first report of tubal malformation with primary vesico-tubal fistula.
Int Urogynecol J
Fig. 1 Vesico-tubal fistula was seen under hysterosalpingo contrast sonography
Fig. 2 The laparoscopy and hysteroscopy examination
Int Urogynecol J
Fig. 3 Vesico-tubal fistula was seen under laparoscopy and cystoscopy by intrauterine injection of
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