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Vesicocutaneous fistula presenting as a thigh abscess
George Sturgess1, George Lane1
1Department of Urology, Pinderfields Hospital, Aberford Road, Wakefield, UK.
Urology Case Reports
|October 21, 2022
Summary
A thigh abscess can indicate intra-abdominal issues or bladder perforation, especially in patients with bladder cancer history. This case highlights a rare vesicocutaneous fistula presenting as a thigh abscess, leading to secondary rectal perforation.
Area of Science:
- Urology
- Surgical Pathology
- Radiology
Background:
- Thigh abscesses are typically linked to intra-abdominal pathology from the gastrointestinal tract.
- Less commonly, bladder-related issues like perforation can cause thigh abscesses, often following pelvic surgery, radiation, or trauma.
Observation:
- A patient with a history of bladder cancer presented with a thigh abscess.
- Initial incision and drainage yielded clear, odorless fluid, which was atypical for a standard abscess.
Findings:
- Computed tomography (CT) scan and retrograde cystogram confirmed a bladder perforation.
- A vesicocutaneous fistula was identified, connecting the bladder to the thigh.
- The patient subsequently developed a rectal perforation, attributed to a pelvic urinoma.
Implications:
- This case underscores the importance of considering bladder perforation in thigh abscesses, particularly in patients with relevant medical histories.
- Prompt diagnosis via imaging is crucial for identifying vesicocutaneous fistulas.
- Management of pelvic urinomas and associated fistulas is critical to prevent further complications like rectal perforation.
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