Vesico-ovarian fistula in suppurative ovarian inflammation and salpingitis

Abstract

The development of fistulas between the bladder and right ovary in a 27-year-old woman is reported. This exceedingly rare form of an internal vesical fistula occurred as a consequence of dextrolateral adnexitis with suppurative ovarian inflammation after placement of an intrauterine pessary. Therapy consisted of removal of the right adnexa, excision of the fistulous duct and suturing of the bladder.

PIP: Reported is a case of vesico-ovarian fistula in the right ovary of a 27- year-old woman. The development of fistulas between the bladder and ovary is an exceedingly rare occurrence; no recent cases have been described in the medical literature. In this case, the patient had worn an intrauterine pessary for contraceptive purposes for the preceding 18 months. She presented with dysuric symptoms and was misdiagnosed as having a urinary tract infection. Persistent microscopic hematuria prompted examination by urethrocystoscopy. Biopsy of the fistulous region showed hyperplastic and follicular chronic urocystitis with no malignant cells. The fistulous duct adhered to the parametrium and was surrounded by pelvioperitonitis. Treatment consisted of removal of the right adnexa, excision of the fistulous duct, and suturing of the bladder. The pessary was removed at the same time. Bacteriological examination revealed Staphylococcus epidermidis infection in the ovary and fistula as well as on the pessary. The histopathologic examination showed a fistulous suppurative inflammation of the right ovary and an ovarian abscess; also detected were granulocytic salpingitis and perisalpingitis. The patient's recovery was uneventful, with no complications. The adnexitis in this case appears attributable to the intrauterine device. As use of intrauterine pessaries becomes more widespread, a bladder-ovary route of inflammation should be considered, especially in women with discernible genital lesions with marked vaginal discharge.