Fatal recurrent ureteroarterial fistulas after exenteration for cervical cancer.
BACKGROUND
Ureteroarterial fistula (UAF) is a rare occurrence. It can be difficult to diagnose with a high mortality. We report a case of a recurrent UAF.


METHODS
A 38-year-old women diagnosed with cervical cancer had undergone pelvic exenteration for severe radiation-induced necrosis with a vesicovaginal and rectovaginal fistula after primary radiation therapy. Hemorrhage into the urinary tract necessitated surgical intervention and vascular repair with a femoral-femoral bypass. Although these measures were effective, the patient died 6 months later following an acute hemorrhage into her conduit. Arteriogram revealed a second UAF.


CONCLUSIONS
When urinary tract bleeding occurs in patients previously diagnosed with a gynecologic malignancy and treated with radiation therapy and extensive surgery with urinary diversion, UAF should be considered in the differential diagnoses.
DePasquale
S E
SE
Brown University School of Medicine, Woman and Infants Hospital, Providence, Rhode Island, 02905-2499, USA.
Mylonas
I
I
Falkenberry
S S
SS
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D009336:Necrosis; D009364:Neoplasm Recurrence, Local; D010385:Pelvic Exenteration / Q000009:adverse effects*; D011832:Radiation Injuries / Q000601:surgery; D011859:Radiography; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D014548:Urinary Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy / Q000601:surgery*