Iatrogenic vesico-jejunal fistula six years following subtotal hysterectomy: diagnostic challenges and management

Abstract

Objective: We present a case of vesico-jejunal fistula occurring 6 years after a subtotal hysterectomy done in a private hospital from use of intra-abdominal nylon sutures.
Case details: The patient is a 50-year-old woman who presented to our facility with 6 months’ history of faecaluria. There was associated history of urinary frequency, urgency, pneumaturia and dysuria. She had subtotal hysterectomy 6 years prior to presentation. Cystography, Abdominal computed tomography scan, and cystoscopy done revealed a bowel fistula with the bladder. She had exploratory laparotomy which revealed extensive intra-abdominal nylon suturing of bladder and jejunum. She was treated and did well postoperatively. Conclusion: Enterovesical fistula can follow wrong suture use in surgical procedures even many years after the procedure. High index of suspicion and imaging modalities are needed for early diagnosis and prompt management.