VESICOUTERINE FISTULA WITH FOETUS IN BLADDER: A RARE COMPLICATION OF PREVIOUS LSCS MANAGED LAPAROSCOPICALLY

Abstract

Vesicouterine fistula (VUF) is an extremely rare subtype of urogenital fistula, commonly associated with previous lower segment caesarean section (LSCS). Migration of a foetus into the urinary bladder through a vesicouterine fistulous tract is very rare.

A 34-year-old multigravida (G3P2) with two previous LSCS presented during pregnancy with haematuria, lower abdominal heaviness, four months of amenorrhoea, and vaginal bleeding. She had a history of cyclical haematuria since her last caesar- ean delivery 13 years ago but had never undergone any evaluation. Ultrasonography revealed a bulky uterus with placental tissue and fluid but no visible foetus, suggesting incomplete abortion. During dilatation and evacuation, a closed cervical os prompted further evaluation with transvaginal ultrasonography and cystoscopy, which demonstrated a dead 12-week foetus, embryonic tissue, and umbilical cord fragments within the urinary bladder, which must have migrated through a 1.5 cm vesicouterine fistulous tract. Emergency laparoscopic surgery was performed with evacuation of foetal tissue from the bladder, excision of the fistulous tract, bladder and uterine repair, and bilateral tubal ligation. The postoperative course was uneventful, and the patient recovered completely following catheter removal on day 14. This case highlights an extremely rare presentation of vesicouterine fistula with foetal migration into the bladder following a previous LSCS. This case is unique due to its delayed symptom onset, the absence of continuous urinary leakage, and a diagnosis established primarily through ultrasonography and cystoscopy. Laparoscopic repair was safe, effective, highlighting the importance of early recognition and definitive surgical management