Vesicovaginal fistula presenting as a large abdominal pseudocyst: A rare case

We present a rare case of indirect vesicovaginal fistula (VVF) in a patient with small capacity bladder. The fistula was between abdominal pseudocyst (APC) arising from bladder and vagina - and hence, an indirect VVF. A 35-year-old female had a history of emergency obstetric hysterectomy with iatrogenic bladder injury. Postoperatively, the patient developed VVF and large APC. Patient's micturating cystourethrogram was suggestive of small capacity bladder with bilateral Grade IV vesicoureteral reflux with a well-defined APC arising from superior surface of bladder to L4-L5 lumbar vertebrae. Large APC arising from bladder and associated with an indirect VVF is very rare, and to the best of our knowledge, this is the first case reported in literature. The patient was successfully managed with exploratory laparotomy and excision of fistula tract and pseudocyst, adhesiolysis, and ileal augmentation cystoplasty. Multiple intraoperative adhesions should be suspected in APC. We would like to conclude that ileal augmentation cystoplasty is a safe procedure in a case of VVF with APC and small capacity bladder.