Iatrogenic vesicocolic fistula after gynecologic surgery: a case report.

INTRODUCTION AND

IMPORTANCE

We present a unique case of a vesicocolic fistula (VCF) that occurred postoperatively after ovarian cyst surgery, caused by the migration of an intraoperatively forgotten gauze into the urinary bladder. This represents a very rare etiology of VCFs.

CASE PRESENTATION: A patient who had undergone surgery for a giant left ovarian cyst 5 months prior presented with recurrent urinary tract infections and an ultrasound image suggestive of a bladder stone. Cystoscopy, contrast-enhanced computed tomography, and colonoscopy confirmed a VCF with an intravesical foreign body. Surgical management consisted of fistula excision, removal of the gauze, bladder repair, and definitive colostomy. Postoperative evolution was favorable, and the patient remained infection-free at 1 year.

CLINICAL DISCUSSION: VCFs are most frequently associated with diverticular disease, whereas iatrogenic causes - particularly due to retained surgical gauze - are extremely rare. This case highlights the diagnostic difficulty when symptoms mimic more common conditions such as recurrent urinary tract infections or bladder stones. Early suspicion of a fistula is crucial in patients with persistent urinary symptoms after pelvic surgery. Management depends on patient factors, comorbidities, and fistula etiology; in this case, advanced age warranted a conservative two-stage approach with a permanent colostomy.

CONCLUSION

In patients with recurrent urinary infections after pelvic surgery and imaging suggestive of bladder stones, clinicians should consider VCF due to migrated foreign bodies in the differential diagnosis.