Vesico-adnexal fistula treated with transurethral embolization under fluoroscopic guidance

• Type of Material: Article
• Authors: Ma'moon H. Al-Omari, Jordan University of Science and Technology; Aws Hamid, Emory University
• Language: English
• Date: 2017-09-04
• Publisher: American Journal of Case Reports
• Publication Version: Final Published Version
• Copyright Statement: © Am J Case Rep, 2017
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.12659/AJCR.904202
• Title of Journal or Parent Work: American Journal of Case Reports
• Volume: 18
• Start Page: 949
• End Page: 952
• Keywords: Embolization, Therapeutic; Humans; Adnexal Diseases; Urinary Bladder Fistula; Fistula; Fluoroscopy; Female; Adult
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Objective: Rare disease Background: Vesico-adnexal fistulae are rare. Potential causes of such fistulae include infection, endometriosis, and iatrogenic causes following pelvic surgeries. To the best of our knowledge, only 3 cases of vesico-adnexal fistulae have been reported, and all these patients were treated surgically by removing the involved adnexa, excising the fistulous duct, and suturing the bladder. We describe the first case of vesico-adnexal fistula that developed after pelvic surgery, and it was successfully treated by transurethral embolization under fluoroscopic guidance. Case Report: Our patient was a 27-year-old woman with a history of hysterectomy. She presented to our institution with urethral discharge and a recurrent urinary tract infection. The cystogram showed a fistula tract connecting the urinary bladder and left adnexal cystic cavity. She was treated conservatively with antibiotics and prolonged Foley catheterization to allow for spontaneous closure of the fistula; however, conservative management failed. The patient was successfully treated with transurethral embolization of the tract under fluoroscopic guidance. Conclusions: In such a rare scenario with limited treatment options, interventional radiology offers an alternative minimally invasive treatment strategy.