Gomez Úrsula Trovato, Pereira Pedro Paulo, Cabar Fábio Roberto, Mesquita José Luiz Borges de, Francisco Rossana Pulcineli Vieira
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2019 Jul 1;17(3):eRC4570. doi: 10.31744/einstein_journal/2019RC4570.
Vesicouterine fistula is a rare condition. Its incidence, however, has been increasing due to the higher incidence of cesarean sections. The presence of a live fetus inside the bladder who passed through a vesicouterine fistula is an extremely rare situation. We report a case of woman who underwent two previous cesarean sections, was referred to a hospital due to mild pelvic pain and genital bleeding. At the moment, physical examination was normal. Ultrasound scan revealed a gestational sac inserted into the anterior wall of the uterus, with a living fetus of approximately 13 weeks, with active body movement and normal heart rate inside it. The fetal abdomen, around the waist, was stuck at the opening of a vesicouterine fistula, so that the fetal head and trunk were entirely into the bladder cavity, while lower limbs remained at the uterine cavity. Laparotomy was performed, the fistulous tract was excised, the fetus (without heart beating) was removed on opening the bladder, and the uterine cavity was emptied. The defects in the bladder and uterus were repaired. The postoperative period was uneventful. A live fetus inside the urinary bladder is a rare condition the continuation of pregnancy is unlikely and the vesicouterine correction can be made by the time of surgical intervention.
膀胱子宫瘘是一种罕见的病症。然而，由于剖宫产率的上升，其发病率一直在增加。膀胱内有一个通过膀胱子宫瘘的活胎儿这种情况极为罕见。我们报告一例曾接受过两次剖宫产的女性病例，因轻度盆腔疼痛和生殖器出血被转诊至一家医院。当时，体格检查正常。超声扫描显示妊娠囊植入子宫前壁，有一个约13周大的活胎儿，胎儿身体活动活跃，心率正常。胎儿腹部在腰部周围卡在膀胱子宫瘘口处，致使胎儿头部和躯干完全进入膀胱腔，而下肢仍留在子宫腔内。进行了剖腹手术，切除了瘘管，打开膀胱时取出了胎儿（已无心跳），并清空了子宫腔。修复了膀胱和子宫的缺损。术后恢复顺利。膀胱内有活胎儿是一种罕见情况，继续妊娠不太可能，且在手术干预时可进行膀胱子宫修复。
