Gan Ling, Xie Lijun, Li Haiying
Department of Ultrasound Medicine, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China.
Department of Ultrasound Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
Heliyon. 2023 Jan 28;9(2):e13268. doi: 10.1016/j.heliyon.2023.e13268. eCollection 2023 Feb.
Vesicouterine fistula (VUF) is a rare complication after cesarean section. It is challenging to diagnose VUF correctly.
A 34-year-old woman complained of recurrent hematuria and urinary tract infection for more than 4 years after cesarean delivery, mostly during menstruation, without vaginal leakage and with a normal menstrual cycle. Conventional transabdominal ultrasound showed no abnormal findings in bilateral kidneys and ureters, bladder and uterus, and transvaginal ultrasound showed that the scar at the lower part of the anterior uterine wall was closely adhered to the posterior wall of the bladder. Considering that the patient had hematuria but no vaginal leakage, we assumed that the fistula was flowing unidirectionally from the uterine cavity to the bladder cavity. Therefore, we chose to inject SonoVue (ultrasound contrast agent) into the uterine cavity rather than into the bladder. After intrauterine injection of SonoVue, the ultrasound contrast agent was seen flowing from the uterine cavity into the bladder cavity through the fistula, showing a hyperechoic fistula between the posterior wall of the bladder and the uterine wall, confirming the diagnosis of VUF. The accuracy of this diagnosis was then further confirmed by both MRI and cystoscopy.
-intrauterine CEUS provides a new effective imaging method for the diagnosis of VUF, especially for patients with fistulas that flow unidirectionally from the uterine cavity.
膀胱子宫瘘（VUF）是剖宫产术后一种罕见的并发症。准确诊断VUF具有挑战性。
一名34岁女性在剖宫产术后4年多来反复出现血尿和尿路感染，主要发生在月经期间，无阴道漏液，月经周期正常。常规经腹超声显示双侧肾脏、输尿管、膀胱及子宫均无异常发现，经阴道超声显示子宫前壁下部瘢痕与膀胱后壁紧密粘连。考虑到患者有血尿但无阴道漏液，我们推测瘘管是从子宫腔单向流入膀胱腔的。因此，我们选择将声诺维（超声造影剂）注入子宫腔而非膀胱。子宫腔内注入声诺维后，可见超声造影剂通过瘘管从子宫腔流入膀胱腔，显示膀胱后壁与子宫壁之间有高回声瘘管，确诊为VUF。MRI和膀胱镜检查进一步证实了该诊断的准确性。
子宫腔内超声造影为VUF的诊断提供了一种新的有效成像方法，尤其适用于瘘管从子宫腔单向流动的患者。
