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Case Report
Vesicouterine fistula following multiple cesarean sections: A case report
1 Department of Obstetrics and Gynecology Kasserine, Sousse University, Kasserine Maternity Center, Tunisia
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Montacer Hafsi
Medical Resident in Gynecology and Obstetrics,
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Article ID: 100189Z08MH2024
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Hafsi M, Zouaghi A, Rhimi K, Ltifi B, Jellali N, Gharsalli R, Armi S. Vesicouterine fistula following multiple cesarean sections: A case report. J Case Rep Images Obstet Gynecol 2024;10(2):62–65.ABSTRACT
Introduction: Vesicouterine fistula, also known as Youssef’s syndrome, is a rare but significant complication primarily arising after cesarean sections. This condition involves an abnormal connection between the bladder and the uterus, which can lead to symptoms such as cyclic hematuria (menstrual blood in the urine) and urinary leakage. The increasing incidence of cesarean deliveries highlights the need for greater awareness and effective management of this condition.
Case Report: We present the case of a 32-year-old woman with a history of multiple cesarean sections who was admitted with spontaneous labor at 36 weeks and 4 days of amenorrhea. Initial diagnostic imaging and clinical assessment indicated a viable pregnancy but revealed a history of extensive intra-abdominal adhesions. During an emergency cesarean section, complications included a bladder injury and a 2 cm uterine rupture. Post-operatively, the persistent presence of hematuria led to further investigation using retrograde urethrocystography (UCR), which confirmed the diagnosis of a vesicouterine fistula. The diagnosis of vesicouterine fistula presents significant challenges due to its rarity and the overlap of symptoms with other conditions such as malignancies or bladder injuries. The condition is often associated with difficult cesarean sections and extensive intra-abdominal adhesions. Accurate diagnosis relies on imaging techniques, particularly UCR, to identify the fistula and guide appropriate surgical intervention. Effective management includes careful surgical repair and post-operative monitoring to resolve the fistula and restore normal bladder and uterine function.
Conclusion: Vesicouterine fistula is a rare but important complication following cesarean sections, requiring prompt recognition, and management. Awareness of its symptoms and the potential for occurrence in patients with a history of multiple cesarean deliveries is essential for early diagnosis. Imaging modalities, such as UCR, are crucial for accurate diagnosis and guiding surgical treatment. Early intervention and careful post-operative care are key to achieving favorable outcomes and preserving reproductive health.
Keywords: Bladder injury, Cesarean section, Intra-abdominal adhesions, Vesicouterine fistula, Youssef’s syndrome
SUPPORTING INFORMATION
Author Contributions
Montacer Hafsi - Substantial contributions to conception and design, Acquisition of data, Final approval of the version to be published
Asma Zouaghi - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Kawther Rhimi - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Besma Ltifi - Acquisition of data, Drafting the article, Final approval of the version to be published
Nejmeddine Jellali - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Rachid Gharsalli - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sawssem Armi - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Montacer Hafsi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
