Can Vesicouterine Fistula Occur as a Complication of Laparotomy, Colostomy, or Appendectomy?
No, vesicouterine fistula does not occur as a complication of laparotomy, colostomy, or appendectomy. Vesicouterine fistula is almost exclusively a complication of cesarean section and, very rarely, vaginal delivery after previous cesarean sections 1, 2, 3.
Etiology of Vesicouterine Fistula
Cesarean section is the predominant cause, accounting for the vast majority of vesicouterine fistulas since 1947, when this complication became more common with the widespread adoption of low segment cesarean sections 3.
The fistula develops from inadvertent bladder injury during dissection of the lower uterine segment at the time of cesarean delivery 1.
Vaginal birth after cesarean (VBAC) represents a rare alternative mechanism, particularly in women with multiple prior cesarean sections where the bladder may be adherent to the uterine scar 4.
Historically, before 1947, vesicouterine fistulas occasionally followed vaginal operative deliveries (forceps or vacuum), but this is now exceedingly rare 3.
Why These Procedures Don't Cause Vesicouterine Fistula
Anatomical Considerations
Laparotomy is simply an abdominal incision approach and does not inherently involve the bladder-uterine interface unless combined with a specific pelvic procedure 5.
Colostomy creates an opening between the colon and abdominal wall, with no anatomical relationship to the bladder-uterine junction 5.
Appendectomy involves the appendix in the right lower quadrant, anatomically distant from the bladder and uterus 5.
Fistulas That CAN Occur with These Procedures
Colostomy-Related Fistulas
- Gastrocolocutaneous fistulas can develop when the colon is inadvertently punctured during gastrostomy placement, but this involves the stomach-colon-skin, not the bladder-uterus 5.
Laparotomy-Related Fistulas
Rectovaginal or rectovesical fistulas may occur as complications of pelvic surgery, radiation therapy, or inflammatory bowel disease, but these involve the rectum-vagina or rectum-bladder connections, not the uterus-bladder 5, 6, 7.
Approximately 11% of colovesical and colovaginal fistulas are caused by malignancy rather than surgical complications 5.
Clinical Presentation of Vesicouterine Fistula
When vesicouterine fistula does occur (after cesarean section), patients present with:
Cyclic hematuria (menouria) - menstruation through the bladder - which is the most characteristic symptom 1, 2, 3.
Amenorrhea due to menstrual blood draining into the bladder rather than through the vagina 1, 2.
Vaginal urinary leakage, though this is less common than with other urogenital fistulas 1, 2.
Recurrent urinary tract infections 1.
Secondary infertility 2.
Key Clinical Pitfall
The critical error would be attributing a vesicouterine fistula to general abdominal surgery when the actual cause is almost certainly an obstetric procedure. If a patient presents with symptoms suggestive of vesicouterine fistula, the history should focus on prior cesarean sections or complicated vaginal deliveries, not appendectomy, colostomy, or non-obstetric laparotomy 1, 2, 3.