A rare case of vesicovaginal fistula following illegal abortion

Abstract

It is estimated that 50-60 million induced abortions take place annually in the world and 19 million are still performed illegally. According to WHO about one quarter to one third of maternal deaths are due to complications of induced abortion. The morbidity and mortality related to criminal abortions is due to complications like haemorrhage perforation sepsis shock and visceral injuries. Bladder injuries due to instrumental perforation of the uterus have been reported but development of a urinary fistula without any instrumentation in induced abortion is rare. We came across such a presentation. A 35-year P/5A/1L/5 illiterate woman presented with continuous dribbling of urine per vaginum following an illegal abortion at 3 months of gestation by a quack 7 months back. According to her some paste was applied in the vagina following which she aborted spontaneously and noticed watery discharge per vaginum. She consulted a doctor for persistent vaginal discharge and was diagnosed as a case of vesicovaginal fistula. Earlier Obstetrc history was uneventful. Her menstrual cycles were normal however following abortion she developed amenorrhoea. Abdominal examination was unremarkable. Speculum examination showed a blind vagina about 6 cm long. Cervix could not be visualized. A small opening (6 mm in diameter) about 4.5 cm from the urethral meatus was seen at the vault. On bimanual examination vagina ended blindly with cicatrization in upper part cervix could not be felt. The margins of the fistula were fibrosed and irregular. On per rectal examination uterus and cervix could not be appreciated properly instead a transverse band was felt. (excerpt)