Iatrogenic Vesicojejunal Fistula Six Years Following Subtotal Hysterectomy: Diagnostic Challenges and Management

Enterovesical fistula represents an abnormal communication between the urinary bladder and the gastrointestinal tract. It can result spontaneously from different disease processes, but can also complicate a surgical procedure. While most involve the large bowel, few involve the small bowel and these present with more clinical problems, as well as challenges in diagnosis and management. The patient is a 50-year-old P₈ ⁺⁰, woman who presented to our facility with a 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 small bowel fistula with the bladder. She had exploratory laparotomy which revealed the fistula and extensive intra-abdominal nylon suturing of bladder and jejunum. She was treated and did well postoperatively. Enterovesical fistula can follow wrong suture use in surgical procedures even many years after the procedure. A high index of suspicion and imaging modalities are needed for early diagnosis and prompt management.