title: Bladder perforation and development of a vesico--vaginal fistula following laparoscopic assisted vaginal hysterectomy: case report.
abstract: Bladder injury with subsequent development of a Vesico-Vaginal Fistula following a Laparoscopic Assisted Vaginal Hysterectomy is reported. The injury was not recognised intra--operatively or in the immediate post-operative period. On the third post-operative day, the patient complained of abdominal distention, and a reduced urine output was noted. There was no haematuria. Conservative management by continuous bladder drainage was not successful. A low-pressure cystogram done on day eight revealed a bladder leakage. On day 21, a repeat low-pressure cystogram showed a vesico-vaginal fistula. A successful transvesical repair by laparotomy was undertaken on day 23. The possible mechanisms of injury, prevention and the principles of management are discussed.
authors.affiliation: Sarit Centre, Nairobi Kenya.
authors.forename: R B
authors.initials: RB
authors.lastname: Parkar
authors.forename: S
authors.initials: S
authors.lastname: Verma
authors.forename: S R
authors.initials: SR
authors.lastname: Samnakay
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D011247:Pregnancy; D012307:Risk Factors; D001743:Urinary Bladder / Q000293:injuries* / Q000503:physiopathology; D014719:Vesicovaginal Fistula / Q000175:diagnosis / Q000209:etiology*